Healthcare Provider Details

I. General information

NPI: 1134278278
Provider Name (Legal Business Name): ATHANASIA VIRGADAMO RNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 RESPONSE RD
SACRAMENTO CA
95815-4807
US

IV. Provider business mailing address

5527 CLARENDON WAY
CARMICHAEL CA
95608-5506
US

V. Phone/Fax

Practice location:
  • Phone: 916-614-4172
  • Fax:
Mailing address:
  • Phone: 916-614-4172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number1161
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: