Individual
AN VO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4604 ROOSEVELT AVE, SACRAMENTO, CA 95820-4520
(916) 457-3129
Mailing address
4604 ROOSEVELT AVE, SACRAMENTO, CA 95820-4520
(916) 457-3129
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
287507
CA
Other
Enumeration date
04/09/2015
Last updated
04/09/2015
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