Provider Demographics
NPI:1790156172
Name:REZNOVA, VERONIKA
Entity Type:Individual
Prefix:
First Name:VERONIKA
Middle Name:
Last Name:REZNOVA
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 1:3635 GROVE ST UNIT 165
Mailing Address - Street 2:
Mailing Address - City:LEMON GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:91945-1845
Mailing Address - Country:US
Mailing Address - Phone:858-335-0764
Mailing Address - Fax:
Practice Address - Street 1:3635 GROVE ST UNIT 165
Practice Address - Street 2:
Practice Address - City:LEMON GROVE
Practice Address - State:CA
Practice Address - Zip Code:91945-1845
Practice Address - Country:US
Practice Address - Phone:858-335-0764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-12
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16748171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist