IndividualActive
Mickey Iliescu
NPI 1386176808 · Custodial Care Facility · Orangevale, CA
Provider details
- NPI number
- 1386176808
- Entity type
- Individual
- Primary specialty
- Custodial Care FacilityNursing & Custodial Care Facilities
- Sex
- Male
- Sole proprietor
- Yes
- License
- 347003704 (CA)
Practice location
7125 Main Ave
Orangevale, CA 95662-2813
Phone: (916) 987-7285
Fax: (916) 987-7165
Mailing address
7111 Main Ave
Orangevale, CA 95662-2813
Registry dates
- Enumerated
- 2017-04-03
- Last updated
- 2017-04-03
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.