Provider Demographics
NPI:1053531392
Name:ALBERTSON, DAVID JAY (RAS CADC II)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:JAY
Last Name:ALBERTSON
Suffix:
Gender:M
Credentials:RAS CADC II
Other - Prefix:MR
Other - First Name:DAVID
Other - Middle Name:SAM
Other - Last Name:ALBERTSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MPSS-QFKVXW
Mailing Address - Street 1:16198 BROOKS RD
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-4314
Mailing Address - Country:US
Mailing Address - Phone:530-559-0979
Mailing Address - Fax:530-559-0979
Practice Address - Street 1:900 E MAIN ST
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5853
Practice Address - Country:US
Practice Address - Phone:530-273-2244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMPSS-QFKVXW175T00000X
CA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No175T00000XOther Service ProvidersPeer Specialist