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General NPI Number Information
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NPI Number | 1992891295
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Entity Type | Individual
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Provider Name | STEPHEN LINDSAY VILTRAKIS M D
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Gender | Male
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3300 RENNER DR.
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City | FORTUNA
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State | CA
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Zip | 95540
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Country | US
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Telephone | 707-725-3361
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Fax |
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Provider Business Mailing Address
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Address Line | P. O. BOX 6640
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City | EUREKA
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State | CA
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Zip | 95502
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Country | US
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Telephone | 707-445-5431
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Fax | 707-445-3710
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | G72357
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License Number State | CA
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