Provider Demographics
NPI:1679149108
Name:LAYCO, OLIVER PALPAL-LATOC
Entity type:Individual
Prefix:
First Name:OLIVER
Middle Name:PALPAL-LATOC
Last Name:LAYCO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9393 MARIUS WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95829-6113
Mailing Address - Country:US
Mailing Address - Phone:916-396-0823
Mailing Address - Fax:
Practice Address - Street 1:9393 MARIUS WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95829-6113
Practice Address - Country:US
Practice Address - Phone:916-396-0823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-03
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA78756225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist