Provider Demographics
NPI:1689357998
Name:IGNATYEVA, NATALYA (PHARMD)
Entity Type:Individual
Prefix:
First Name:NATALYA
Middle Name:
Last Name:IGNATYEVA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9475 MALER RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-3816
Mailing Address - Country:US
Mailing Address - Phone:858-945-5144
Mailing Address - Fax:
Practice Address - Street 1:5550 CARMEL MOUNTAIN RD STE 111
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-4861
Practice Address - Country:US
Practice Address - Phone:858-925-6149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-11
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86139183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist