Provider Demographics
NPI:1477932929
Name:NEVEROV-KRSTIC, VIKTORIYA (LAC)
Entity Type:Individual
Prefix:
First Name:VIKTORIYA
Middle Name:
Last Name:NEVEROV-KRSTIC
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 MONTECITO AVE
Mailing Address - Street 2:APT 3
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-3486
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:669 CRESPI DR
Practice Address - Street 2:SUITE A
Practice Address - City:PACIFICA
Practice Address - State:CA
Practice Address - Zip Code:94044-3486
Practice Address - Country:US
Practice Address - Phone:916-502-4092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-28
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 16317171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist