Provider Demographics
NPI:1396799425
Name:ILIE, RAZVAN (FNP, DC)
Entity type:Individual
Prefix:DR
First Name:RAZVAN
Middle Name:
Last Name:ILIE
Suffix:
Gender:M
Credentials:FNP, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:888 CAMPUS COMMONS RD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-6632
Mailing Address - Country:US
Mailing Address - Phone:916-804-0645
Mailing Address - Fax:916-550-5003
Practice Address - Street 1:3701 J ST
Practice Address - Street 2:STE 201
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5562
Practice Address - Country:US
Practice Address - Phone:916-454-2345
Practice Address - Fax:916-550-5003
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA777273163W00000X
CA95002192363LF0000X
CADC30043111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV10061Medicare UPIN