Healthcare Provider Details

I. General information

NPI: 1992371512
Provider Name (Legal Business Name): YAE VUE LVN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2021
Last Update Date: 06/03/2021
Certification Date: 06/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7240 E SOUTHGATE DR STE G
SACRAMENTO CA
95823-2627
US

IV. Provider business mailing address

7788 LARAMORE WAY
SACRAMENTO CA
95832-1410
US

V. Phone/Fax

Practice location:
  • Phone: 916-391-4293
  • Fax: 916-391-4247
Mailing address:
  • Phone: 916-207-6456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number253417
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: