Provider Demographics
NPI:1649895855
Name:PAPKOV, VYACHESLAV
Entity type:Individual
Prefix:
First Name:VYACHESLAV
Middle Name:
Last Name:PAPKOV
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 1:8518 STORY RIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:ANTELOPE
Mailing Address - State:CA
Mailing Address - Zip Code:95843-5232
Mailing Address - Country:US
Mailing Address - Phone:612-396-8675
Mailing Address - Fax:
Practice Address - Street 1:5250 DATE AVE STE G
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95841-2564
Practice Address - Country:US
Practice Address - Phone:612-396-8675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-12
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)