Individual
REBECCA SPRAGUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NPC
Contact information
Practice address
3835 J STREET, SACRAMENTO, CA 95816-5520
(916) 456-0400
(916) 340-0621
Mailing address
3835 J STREET, SACRAMENTO, CA 95816-5520
(916) 456-0400
(916) 340-0621
Taxonomy
Speciality
Code
Description
License number
State
207NS0135X
Procedural Dermatology Physician
11828
CA
207RC0000X
Cardiovascular Disease Physician
Primary
NP11828
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0068230
—
CA
05
—
GR0068231
—
CA
05
—
GR0068232
—
CA
05
—
GR0068233
—
CA
05
—
GR0068235
—
CA
05
—
GR006823B
—
CA
05
—
RN314798
—
CA
01
—
ZZZ47673Z
BLUE SHIELD
CA
01
—
ZZZ47675Z
BLUE SHIELD
CA
01
—
ZZZ47676Z
BLUE SHIELD
CA
01
—
ZZZ62306Z
BLUE SHIELD
CA
Enumeration date
11/28/2006
Last updated
01/30/2008
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