Healthcare Provider Details

I. General information

NPI: 1912477373
Provider Name (Legal Business Name): YULIYA KYRYLYUK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2018
Last Update Date: 11/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

768 PLEASANT VALLEY RD STE 201
DIAMOND SPRINGS CA
95619-9260
US

IV. Provider business mailing address

3830 THORNWOOD DR
SACRAMENTO CA
95821-3756
US

V. Phone/Fax

Practice location:
  • Phone: 530-295-6909
  • Fax:
Mailing address:
  • Phone: 916-793-5436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: