Provider Demographics
NPI:1639507593
Name:ZALESOV, VIKTORIA
Entity Type:Individual
Prefix:MRS
First Name:VIKTORIA
Middle Name:
Last Name:ZALESOV
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 1:9815 52ND AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33708-3715
Mailing Address - Country:US
Mailing Address - Phone:727-202-5018
Mailing Address - Fax:727-202-5018
Practice Address - Street 1:9815 52ND AVE N
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33708-3715
Practice Address - Country:US
Practice Address - Phone:727-202-5018
Practice Address - Fax:727-202-5018
Is Sole Proprietor?:No
Enumeration Date:2013-10-30
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL233118372500000X, 372600000X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009607900Medicaid