Basic Information
| Provider Information | |||||||||
| NPI: | 1396799425 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ILIE | ||||||||
| FirstName: | RAZVAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | FNP, DC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 888 CAMPUS COMMONS RD | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958256632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9168040645 | ||||||||
| FaxNumber: | 9165505003 | ||||||||
| Practice Location | |||||||||
| Address1: | 3701 J ST | ||||||||
| Address2: | STE 201 | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958165562 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164542345 | ||||||||
| FaxNumber: | 9165505003 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2006 | ||||||||
| LastUpdateDate: | 04/17/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 777273 | CA | N | Nursing Service Providers | Registered Nurse | 363LF0000X | 95002192 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 111N00000X | DC30043 | CA | N | Chiropractic Providers | Chiropractor |
No ID Information.