Healthcare Provider Details

I. General information

NPI: 1770907453
Provider Name (Legal Business Name): VASANTHI KRISHNA MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2014
Last Update Date: 12/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 PRAIRIE CITY RD SUITE NO: 120-125
FOLSOM CA
95630-9592
US

IV. Provider business mailing address

1710 PRAIRIE CITY RD SUITE NO: 120-125
FOLSOM CA
95630-9592
US

V. Phone/Fax

Practice location:
  • Phone: 916-512-3356
  • Fax: 916-512-3322
Mailing address:
  • Phone: 916-512-3356
  • Fax: 916-512-3322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License NumberA119222
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License NumberA119222
License Number StateCA

VIII. Authorized Official

Name: VASANTHI KRISHNA
Title or Position: CEO
Credential: MD
Phone: 916-512-3356