Healthcare Provider Details

I. General information

NPI: 1013713510
Provider Name (Legal Business Name): VLADIMIR LOUIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2025
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 ARNOLD DR
MARTINEZ CA
94553-4189
US

IV. Provider business mailing address

1340 ARNOLD DR
MARTINEZ CA
94553-4189
US

V. Phone/Fax

Practice location:
  • Phone: 925-957-5050
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number635669
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: