Healthcare Provider Details

I. General information

NPI: 1326452772
Provider Name (Legal Business Name): ANDREAS VIHLBORG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2014
Last Update Date: 06/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2131 CAPITOL AVE STE 307
SACRAMENTO CA
95816
US

IV. Provider business mailing address

3125 FRANKLIN BLVD
SACRAMENTO CA
95818
US

V. Phone/Fax

Practice location:
  • Phone: 916-642-9943
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number37614
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: