Provider Demographics
NPI:1922205814
Name:BARANOVSKY, SVETLANA (MD)
Entity Type:Individual
Prefix:
First Name:SVETLANA
Middle Name:
Last Name:BARANOVSKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7601 CANBY AVE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-2953
Mailing Address - Country:US
Mailing Address - Phone:818-757-1919
Mailing Address - Fax:818-757-3134
Practice Address - Street 1:7601 CANBY AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-2953
Practice Address - Country:US
Practice Address - Phone:818-757-1919
Practice Address - Fax:818-757-3134
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53350207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG30010Medicare UPIN