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Specialty details in registry · Roseville, CA

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At a glance

7553 Millport Dr, Roseville, CA 95678-2917

NPPES record updated Oct 12, 2016. Public records can lag behind changes at a practice.

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Practice location

7553 Millport Dr
Roseville, CA 95678-2917

Professional details: NPI, taxonomy & registry record

NPI1861942005

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Registry details

Primary taxonomy: Specialty details in registry
Taxonomy code: 251300000X
Enumeration date: Oct 12, 2016
Record updated: Oct 12, 2016

More registry details

Provider type: Organization · Type 2

Reported taxonomies and licenses

Specialty details in registry

251300000X · Primary

License reported: SP 16120 CA

License numbers and credentials are reported to NPPES; HCPList does not independently verify them.

Practice location

7553 Millport Dr
Roseville, CA 95678-2917

Phone: (916) 715-0652

Mailing address

7553 MILLPORT DR

ROSEVILLE, CA 956782917

Source: NPPES Source through Oct 18, 2026An NPI does not verify licensure or credentials.

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