Provider Demographics
NPI:1568638302
Name:USMANOVA, NATALIA
Entity Type:Individual
Prefix:MRS
First Name:NATALIA
Middle Name:
Last Name:USMANOVA
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 1:18044 VALLEY VISTA BLVD
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-4223
Mailing Address - Country:US
Mailing Address - Phone:818-943-8454
Mailing Address - Fax:619-393-0830
Practice Address - Street 1:18044 VALLEY VISTA BLVD
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-4223
Practice Address - Country:US
Practice Address - Phone:818-943-8454
Practice Address - Fax:619-393-0830
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13099363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical