Provider Demographics
NPI:1740547710
Name:GAINES, DAVID
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:GAINES
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:PO BOX 254788
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95865-4788
Mailing Address - Country:US
Mailing Address - Phone:916-877-5220
Mailing Address - Fax:
Practice Address - Street 1:2030 W EL CAMINO AVE STE 260
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95833-1868
Practice Address - Country:US
Practice Address - Phone:916-877-5220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-16
Last Update Date:2021-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator