Provider Demographics
NPI:1285285692
Name:SINGH, VIJAYATA PRISCILLA
Entity type:Individual
Prefix:
First Name:VIJAYATA
Middle Name:PRISCILLA
Last Name:SINGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8515 ELK GROVE FLORIN RD APT 224
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-9554
Mailing Address - Country:US
Mailing Address - Phone:916-588-0504
Mailing Address - Fax:
Practice Address - Street 1:8515 ELK GROVE FLORIN RD APT 224
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-9554
Practice Address - Country:US
Practice Address - Phone:916-588-0504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA694658164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse