Basic Information
| Provider Information | |||||||||
| NPI: | 1346254216 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BANTEA | ||||||||
| FirstName: | VIORICA | ||||||||
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| NameSuffix: | II | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3441 MARYSVILLE BLVD | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958384512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9165637200 | ||||||||
| FaxNumber: | 9165637229 | ||||||||
| Practice Location | |||||||||
| Address1: | 6137 WATT AVE STE 5 | ||||||||
| Address2: | |||||||||
| City: | NORTH HIGHLANDS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956604291 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9163392229 | ||||||||
| FaxNumber: | 9163392609 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PA14564 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.