Provider Demographics
NPI:1306129853
Name:FIJIAN ANGEL CARE
Entity type:Organization
Organization Name:FIJIAN ANGEL CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VENAISI
Authorized Official - Middle Name:V
Authorized Official - Last Name:TAUKEINIKORO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-476-3325
Mailing Address - Street 1:4757 J ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:96819
Mailing Address - Country:US
Mailing Address - Phone:916-476-3325
Mailing Address - Fax:
Practice Address - Street 1:4757 J ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-3700
Practice Address - Country:US
Practice Address - Phone:916-476-3325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIJIAN ANGEL CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA155056302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization