Provider Demographics
NPI:1841684925
Name:VAKULCHIK, VASILY
Entity type:Individual
Prefix:MR
First Name:VASILY
Middle Name:
Last Name:VAKULCHIK
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 1:10737 ROBOLA WAY
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-6941
Mailing Address - Country:US
Mailing Address - Phone:916-247-4484
Mailing Address - Fax:
Practice Address - Street 1:10737 ROBOLA WAY
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-6941
Practice Address - Country:US
Practice Address - Phone:916-247-4484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-26
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7ASZ860347C00000X
CAB9221791171R00000X
CA7NXK276343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle
No171R00000XOther Service ProvidersInterpreter