Provider Demographics
NPI:1871928135
Name:BUDNEVSKA-SIRA, VIRA (PAC)
Entity type:Individual
Prefix:
First Name:VIRA
Middle Name:
Last Name:BUDNEVSKA-SIRA
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2750 GATEWAY OAKS DR 310
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95833-3658
Mailing Address - Country:US
Mailing Address - Phone:916-887-7398
Mailing Address - Fax:
Practice Address - Street 1:2800 L ST STE 300
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5616
Practice Address - Country:US
Practice Address - Phone:916-453-3300
Practice Address - Fax:916-454-6822
Is Sole Proprietor?:No
Enumeration Date:2013-09-05
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23088363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant