Healthcare Provider Details

I. General information

NPI: 1841684925
Provider Name (Legal Business Name): MR. VASILY VAKULCHIK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2015
Last Update Date: 01/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10737 ROBOLA WAY
RANCHO CORDOVA CA
95670-6941
US

IV. Provider business mailing address

10737 ROBOLA WAY
RANCHO CORDOVA CA
95670-6941
US

V. Phone/Fax

Practice location:
  • Phone: 916-247-4484
  • Fax:
Mailing address:
  • Phone: 916-247-4484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number7ASZ860
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171R00000X
TaxonomyInterpreter
License NumberB9221791
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number7NXK276
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: