Provider Demographics
NPI:1649476243
Name:ARMISEN, VALESKA (MD)
Entity type:Individual
Prefix:DR
First Name:VALESKA
Middle Name:
Last Name:ARMISEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:VAL
Other - Middle Name:
Other - Last Name:ARMISEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:10470 OLD PLACERVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:3133 PROFESSIONAL DR
Practice Address - Street 2:SUITE 20
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-2463
Practice Address - Country:US
Practice Address - Phone:530-885-8821
Practice Address - Fax:530-885-6554
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72580207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA112596Medicare PIN
CAH53995Medicare UPIN