Provider Demographics
NPI:1760198865
Name:PRICE, VIRGIL MARCUS JR
Entity Type:Individual
Prefix:
First Name:VIRGIL
Middle Name:MARCUS
Last Name:PRICE
Suffix:JR
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:PO BOX 581145
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-0020
Mailing Address - Country:US
Mailing Address - Phone:916-798-8030
Mailing Address - Fax:
Practice Address - Street 1:9748 EAGLE GLEN WAY
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95757-2617
Practice Address - Country:US
Practice Address - Phone:916-798-8030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA88-4166418Medicaid