Healthcare Provider Details

I. General information

NPI: 1356813174
Provider Name (Legal Business Name): ANASTASIIA ZAGORUIKO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2018
Last Update Date: 12/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4540 HARLIN DR
SACRAMENTO CA
95826-9716
US

IV. Provider business mailing address

3703 JONKO AVE
NORTH HIGHLANDS CA
95660-5205
US

V. Phone/Fax

Practice location:
  • Phone: 916-364-7800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: