=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396963997
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTOPHER J PILACZYNSKI PA-C
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/22/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 530 UNION AVE
-----------------------------------------------------
City | FAIRFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94533-6367
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-421-7151
-----------------------------------------------------
Fax | 707-421-6674
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 397 OAK VALLEY DR
-----------------------------------------------------
City | VACAVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95687-7113
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-446-2164
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | PA18727
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------