Provider Demographics
NPI:1508689290
Name:SACCO, JAMES J
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:J
Last Name:SACCO
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 1:219 WOODHILL DR
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-2929
Mailing Address - Country:US
Mailing Address - Phone:916-289-6147
Mailing Address - Fax:
Practice Address - Street 1:219 WOODHILL DR
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96003-2929
Practice Address - Country:US
Practice Address - Phone:916-289-6147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-01
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133NN1002X, 171400000X
CA5550956208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation