Healthcare Provider Details

I. General information

NPI: 1902193246
Provider Name (Legal Business Name): VLADISLAV AFANASEVICH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2011
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2008 MORSE AVE FL 2
SACRAMENTO CA
95825-2135
US

IV. Provider business mailing address

2008 MORSE AVE FL 2
SACRAMENTO CA
95825-2135
US

V. Phone/Fax

Practice location:
  • Phone: 916-755-1301
  • Fax: 916-973-7220
Mailing address:
  • Phone: 916-755-1301
  • Fax: 916-973-7220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA127495
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA127495
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: