Healthcare Provider Details

I. General information

NPI: 1568282986
Provider Name (Legal Business Name): ANASTASIYA KHOROVETS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2024
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1446 ETHAN WAY STE 77
SACRAMENTO CA
95825-2234
US

IV. Provider business mailing address

4930 HEMLOCK ST
SACRAMENTO CA
95841-3012
US

V. Phone/Fax

Practice location:
  • Phone: 916-968-0553
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: