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4112 Crestline Ave Fair Oaks CA 95628-7103 | |
| (916) 903-7778 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 4112 Crestline Ave, Fair Oaks, California |
| Authorized Official Name and Position | Emeka Ekwuru (GROUP ADMIN) |
| Authorized Official Contact | 9162819003 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
915 Highland Pointe Dr Ste 250 Roseville CA 95678-5421 Ph: (916) 281-9003 | 4112 Crestline Ave Fair Oaks CA 95628-7103 Ph: (916) 903-7778 |
| NPI Number | 1528625209 |
|---|---|
| Provider Enumeration Date | 05/29/2019 |
| Last Update Date | 05/18/2021 |
| Certification Date | 05/18/2021 |
| Medicare PECOS PAC ID | 0547625287 |
|---|---|
| Medicare Enrollment ID | O20230502000511 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528625209 | NPI | - | NPPES |
| Provider Name | Michelle Lyn Saeteurn |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1306165006 PECOS PAC ID: 6800263054 Enrollment ID: I20221101002874 |
| Provider Name | Raven Cross |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114596624 PECOS PAC ID: 6800265257 Enrollment ID: I20221207002371 |
| Provider Name | Arthur Robert Magana |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1811152861 PECOS PAC ID: 0648417816 Enrollment ID: I20230920001579 |
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