Provider Demographics
NPI:1689418022
Name:VANG, TXAWJVAAG ROCKY
Entity type:Individual
Prefix:
First Name:TXAWJVAAG
Middle Name:ROCKY
Last Name:VANG
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 1:42 N SHELLY AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-3648
Mailing Address - Country:US
Mailing Address - Phone:559-348-3871
Mailing Address - Fax:
Practice Address - Street 1:42 N SHELLY AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-3648
Practice Address - Country:US
Practice Address - Phone:559-348-3871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-20
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility