MEDICARE: MR. VASILY VAKULCHIK

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	347C00000X	Private Vehicle	7ASZ860	CA
2	171R00000X	Interpreter	B9221791	CA
3	343900000X	Non-emergency Medical Transport (VAN)	7NXK276	CA

General Provider Information

NPI Number	:	1841684925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. VASILY VAKULCHIK

Provider Business Mailing Address
First Line	:	10737 ROBOLA WAY
Second Line	:
City	:	RANCHO CORDOVA
State	:	CA
Zip	:	95670-6941
Country	:	US
Telephone Number	:	916-247-4484
Fax Number	:

Provider Business Practice Location Address
First Line	:	10737 ROBOLA WAY
Second Line	:
City	:	RANCHO CORDOVA
State	:	CA
Zip	:	95670-6941
Country	:	US
Telephone Number	:	916-247-4484
Fax Number	:

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

Provider Enumeration Date	:	03/26/2015
Last Update Date	:	01/04/2016

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