Provider Demographics
NPI:1922140045
Name:DUVENECK, MICHAL JOHN
Entity Type:Individual
Prefix:DR
First Name:MICHAL
Middle Name:JOHN
Last Name:DUVENECK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 EL SUR WAY
Mailing Address - Street 2:SUITE D
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95864-3008
Mailing Address - Country:US
Mailing Address - Phone:916-481-8008
Mailing Address - Fax:
Practice Address - Street 1:1209 EL SUR WAY
Practice Address - Street 2:SUITE D
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95864-3008
Practice Address - Country:US
Practice Address - Phone:916-481-8008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 9750251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health