Individual
KENYA DESAUTELS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPO
Contact information
Practice address
1411 SECRET RAVINE PKWY STE 100, ROSEVILLE, CA 95661-6042
(916) 784-6900
(916) 784-6901
Mailing address
1411 SECRET RAVINE PKWY STE 100, ROSEVILLE, CA 95661-6042
(916) 784-6900
(916) 784-6901
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
Primary
—
—
224P00000X
Prosthetist
—
—
Other
Enumeration date
09/19/2017
Last updated
07/21/2022
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