Healthcare Provider Details

I. General information

NPI: 1316859648
Provider Name (Legal Business Name): NAFIK AKHMEDOV
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 HARDING BLVD
ROSEVILLE CA
95678-2470
US

IV. Provider business mailing address

7222 LA LUNA CT
CITRUS HEIGHTS CA
95621-6476
US

V. Phone/Fax

Practice location:
  • Phone: 916-664-6644
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number100215
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: