Healthcare Provider Details

I. General information

NPI: 1649893009
Provider Name (Legal Business Name): VALERY D. TARASENKO, MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2020
Last Update Date: 05/20/2020
Certification Date: 05/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5255 ELKHORN BLVD
SACRAMENTO CA
95842-2506
US

IV. Provider business mailing address

200 BUTCHER RD
VACAVILLE CA
95687-5616
US

V. Phone/Fax

Practice location:
  • Phone: 916-334-1100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MILA TARASENKO
Title or Position: MANAGER
Credential:
Phone: 707-359-2255