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Individual

COLETTE AUGUSTINA KAVANAUGH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
L.E.

Contact information

Practice address
1721 EASTERN AVE STE 2, SACRAMENTO, CA 95864-1745
(916) 838-8240
Mailing address
3437 MAUREEN DR, SACRAMENTO, CA 95821-3114
(916) 838-8240

Taxonomy

Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
9736
CA

Other

Enumeration date
06/01/2022
Last updated
04/30/2024
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