Provider Demographics
NPI:1467558783
Name:SACRAMENTO COUNTY DHHS
Entity Type:Organization
Organization Name:SACRAMENTO COUNTY DHHS
Other - Org Name:AS ABOVE
Other - Org Type:Other Name
Authorized Official - Title/Position:LVN
Authorized Official - Prefix:MRS
Authorized Official - First Name:ESTELITA
Authorized Official - Middle Name:D
Authorized Official - Last Name:AVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-875-0802
Mailing Address - Street 1:6808 RIO TEJO WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-3432
Mailing Address - Country:US
Mailing Address - Phone:916-875-0802
Mailing Address - Fax:916-875-0854
Practice Address - Street 1:6808 RIO TEJO WAY
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95757-3432
Practice Address - Country:US
Practice Address - Phone:916-875-0802
Practice Address - Fax:916-875-0854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN111149261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center