MEDICARE: MRS. VIKTORIIA KHABIBRAKHMANOVA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1164388914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VIKTORIIA KHABIBRAKHMANOVA

Provider Business Mailing Address
First Line	:	5381 SABLEWOOD LN
Second Line	:
City	:	FAIR OAKS
State	:	CA
Zip	:	95628-3175
Country	:	US
Telephone Number	:	916-805-4567
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 CREEKSIDE RIDGE CT # 215
Second Line	:
City	:	ROSEVILLE
State	:	CA
Zip	:	95678-3595
Country	:	US
Telephone Number	:	916-659-0003
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/24/2025
Last Update Date	:	12/24/2025

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