Healthcare Provider Details

I. General information

NPI: 1720430721
Provider Name (Legal Business Name): ANNA ZAGRAYCHUK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2016
Last Update Date: 07/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24625 ARCH ST
NEWHALL CA
91321-1111
US

IV. Provider business mailing address

24625 ARCH ST
NEWHALL CA
91321-1111
US

V. Phone/Fax

Practice location:
  • Phone: 661-288-2644
  • Fax: 661-288-2669
Mailing address:
  • Phone: 661-288-2644
  • Fax: 661-288-2669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN250775
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: