MEDICARE: DORA ELVA BUCKHALTER PHYSICIAN ASSISTANT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA 16135	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PA16135	OTHER	CA	CALIFORNIA LICENSE NUMBER

General Provider Information

NPI Number	:	1962453902
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DORA ELVA BUCKHALTER PHYSICIAN ASSISTANT

Provider Business Mailing Address
First Line	:	7501 HOSPITAL DR STE 203
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95823-5405
Country	:	US
Telephone Number	:	916-681-1130
Fax Number	:	916-681-1133

Provider Business Practice Location Address
First Line	:	7501 HOSPITAL DR STE 203
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95823-5405
Country	:	US
Telephone Number	:	916-681-1130
Fax Number	:	916-681-1133

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	03/23/2026

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