Healthcare Provider Details

I. General information

NPI: 1659061067
Provider Name (Legal Business Name): ANNA VAKLINOV
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2023
Last Update Date: 05/09/2023
Certification Date: 05/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28850 LEON RD
WINCHESTER CA
92596-9533
US

IV. Provider business mailing address

31123 JANELLE LN
WINCHESTER CA
92596-8898
US

V. Phone/Fax

Practice location:
  • Phone: 619-980-8528
  • Fax: 844-514-3994
Mailing address:
  • Phone: 619-980-8528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: