Provider Demographics
NPI:1922471747
Name:VIRTUOSO PSYCHIATRY GROUP
Entity Type:Organization
Organization Name:VIRTUOSO PSYCHIATRY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHACHARAWUT
Authorized Official - Middle Name:J
Authorized Official - Last Name:KANCHANANAKHIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-902-7875
Mailing Address - Street 1:5040 WOODSPRING CT
Mailing Address - Street 2:
Mailing Address - City:GRANITE BAY
Mailing Address - State:CA
Mailing Address - Zip Code:95746-8838
Mailing Address - Country:US
Mailing Address - Phone:530-902-7875
Mailing Address - Fax:916-784-2610
Practice Address - Street 1:5040 WOODSPRING CT
Practice Address - Street 2:
Practice Address - City:GRANITE BAY
Practice Address - State:CA
Practice Address - Zip Code:95746-8838
Practice Address - Country:US
Practice Address - Phone:530-902-7875
Practice Address - Fax:916-784-2610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-02
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA91530261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)