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General NPI Number Information
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NPI Number | 1922471747
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Entity Type | Organization
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Legal Business Name | VIRTUOSO PSYCHIATRY GROUP
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Dates
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Enumeration Date | 11/02/2015
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Last Update Date | 11/02/2015
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Provider Practice Location Address
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Address Line | 5040 WOODSPRING CT
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City | GRANITE BAY
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State | CA
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Zip | 95746-8838
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Country | US
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Telephone | 530-902-7875
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Fax | 916-784-2610
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Provider Business Mailing Address
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Address Line | 5040 WOODSPRING CT
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City | GRANITE BAY
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State | CA
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Zip | 95746-8838
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Country | US
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Telephone | 530-902-7875
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Fax | 916-784-2610
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PHACHARAWUT J KANCHANANAKHIN
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Credential | MD
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Telephone | 530-902-7875
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | A91530
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License Number State | CA
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