Provider Demographics
NPI:1275979486
Name:NOSOVITSKIY, IGOR (MS, CPT)
Entity Type:Individual
Prefix:MR
First Name:IGOR
Middle Name:
Last Name:NOSOVITSKIY
Suffix:
Gender:M
Credentials:MS, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 SISKIYOU DR
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2116
Mailing Address - Country:US
Mailing Address - Phone:925-280-8924
Mailing Address - Fax:
Practice Address - Street 1:1511 SISKIYOU DR
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2116
Practice Address - Country:US
Practice Address - Phone:925-280-8924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-14
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program