Provider Demographics
NPI:1598148033
Name:KOZLOVA, YULYA
Entity Type:Individual
Prefix:
First Name:YULYA
Middle Name:
Last Name:KOZLOVA
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 1:950 CANTERBURY ST
Mailing Address - Street 2:APT # 7-B
Mailing Address - City:ROSLINDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02131-4712
Mailing Address - Country:US
Mailing Address - Phone:617-947-1312
Mailing Address - Fax:
Practice Address - Street 1:950 CANTERBURY ST
Practice Address - Street 2:APT # 7-B
Practice Address - City:ROSLINDALE
Practice Address - State:MA
Practice Address - Zip Code:02131-4712
Practice Address - Country:US
Practice Address - Phone:617-947-1312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-01
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA278789207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology