Healthcare Provider Details

I. General information

NPI: 1417367269
Provider Name (Legal Business Name): DR. TIMOTHY KRASNANSKY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2014
Last Update Date: 05/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VALINE CT
SACRAMENTO CA
95831-1603
US

IV. Provider business mailing address

1 VALINE CT.
SACRAMENTO CA
95831
US

V. Phone/Fax

Practice location:
  • Phone: 916-391-3677
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number14042
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: