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General NPI Number Information
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NPI Number | 1114323029
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Entity Type | Individual
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Provider Name | PAVEL KRYLOV NURSE PRACTITIONER
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Gender | Male
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Dates
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Enumeration Date | 11/05/2014
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Last Update Date | 07/05/2023
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Provider Practice Location Address
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Address Line | 2315 STOCKTON BLVD
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City | SACRAMENTO
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State | CA
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Zip | 95817-2201
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Country | US
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Telephone | 916-734-2011
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Fax |
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Provider Business Mailing Address
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Address Line | 1161 EVELYN LN
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City | SACRAMENTO
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State | CA
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Zip | 95864-3754
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Country | US
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Telephone | 415-694-2735
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 86065943
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95025742
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License Number State | CA
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