Provider Demographics
NPI:1760842850
Name:KADIRBEKOV, JASURBEK R (SA-C)
Entity Type:Individual
Prefix:
First Name:JASURBEK
Middle Name:R
Last Name:KADIRBEKOV
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 WHITTINGHAM LN
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-7206
Mailing Address - Country:US
Mailing Address - Phone:386-237-2268
Mailing Address - Fax:
Practice Address - Street 1:36 WHITTINGHAM LN
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-7206
Practice Address - Country:US
Practice Address - Phone:386-237-2268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-02
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13-192246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant