Provider Demographics
NPI:1376830455
Name:RATEVOSIAN, VERONICA (PA)
Entity Type:Individual
Prefix:MRS
First Name:VERONICA
Middle Name:
Last Name:RATEVOSIAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9400 BRIGHTON WAY
Mailing Address - Street 2:STE 410
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4711
Mailing Address - Country:US
Mailing Address - Phone:818-427-4700
Mailing Address - Fax:
Practice Address - Street 1:9400 BRIGHTON WAY STE 410
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4711
Practice Address - Country:US
Practice Address - Phone:319-256-2426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-08
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA21627363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant