Healthcare Provider Details

I. General information

NPI: 1790741734
Provider Name (Legal Business Name): VASANTHI KRISHNA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VASANTHI KRISHNA M.D.,

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 11/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 SCRIPPS DRIVE SUITE 210
SACRAMENTO CA
95825-7977
US

IV. Provider business mailing address

87 SCRIPPS DR STE 210
SACRAMENTO CA
95825-6372
US

V. Phone/Fax

Practice location:
  • Phone: 916-333-5311
  • Fax: 916-333-5990
Mailing address:
  • Phone: 916-333-5311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA11222
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number35.086738
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License NumberA119222
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License NumberA119222
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: