Provider Demographics
NPI:1346004397
Name:CUSTURA, VLAD
Entity Type:Individual
Prefix:MR
First Name:VLAD
Middle Name:
Last Name:CUSTURA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6307 GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-3444
Mailing Address - Country:US
Mailing Address - Phone:916-462-4409
Mailing Address - Fax:
Practice Address - Street 1:6307 GRANT AVE
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-3444
Practice Address - Country:US
Practice Address - Phone:916-462-4409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA342700429310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility