Provider Demographics
NPI:1497197834
Name:IZAAK, ALEVTYNA (REGISTERED NURSE BSN)
Entity Type:Individual
Prefix:
First Name:ALEVTYNA
Middle Name:
Last Name:IZAAK
Suffix:
Gender:F
Credentials:REGISTERED NURSE BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 22ND ST APT 2A
Mailing Address - Street 2:
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-2511
Mailing Address - Country:US
Mailing Address - Phone:310-970-2582
Mailing Address - Fax:
Practice Address - Street 1:128 22ND ST APT 2A
Practice Address - Street 2:
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-2511
Practice Address - Country:US
Practice Address - Phone:310-970-2582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-26
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA841843163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse