Provider Demographics
NPI:1083345508
Name:SPIASIUTSAVA, SVIATLANA
Entity Type:Individual
Prefix:
First Name:SVIATLANA
Middle Name:
Last Name:SPIASIUTSAVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 SHATTO PL APT 314
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-1773
Mailing Address - Country:US
Mailing Address - Phone:323-742-0802
Mailing Address - Fax:
Practice Address - Street 1:1561 WESTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-5601
Practice Address - Country:US
Practice Address - Phone:424-274-1550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-24
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19345171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist