Healthcare Provider Details

I. General information

NPI: 1487056149
Provider Name (Legal Business Name): VILAILUK HER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2014
Last Update Date: 09/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3737 MARCONI AVE
SACRAMENTO CA
95821-5303
US

IV. Provider business mailing address

3737 MARCONI AVE
SACRAMENTO CA
95821-5303
US

V. Phone/Fax

Practice location:
  • Phone: 916-480-1801
  • Fax: 916-874-1809
Mailing address:
  • Phone: 916-480-1801
  • Fax: 916-874-1809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: