Provider Demographics
NPI:1184804148
Name:CHANG, ETHEL J
Entity type:Individual
Prefix:MS
First Name:ETHEL
Middle Name:J
Last Name:CHANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3159 RIDGEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-4460
Mailing Address - Country:US
Mailing Address - Phone:916-933-1075
Mailing Address - Fax:
Practice Address - Street 1:3700 BUSINESS DR
Practice Address - Street 2:SUITE 130
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95820-2140
Practice Address - Country:US
Practice Address - Phone:916-734-8307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA171M00000XOtherUC DAVIS CARE MANAGEMENT