Provider Demographics
NPI:1962030791
Name:GASIMOVA, ULVIYYA
Entity Type:Individual
Prefix:
First Name:ULVIYYA
Middle Name:
Last Name:GASIMOVA
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 1:1302 COMMONWEALTH AVE APT 14
Mailing Address - Street 2:
Mailing Address - City:ALLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02134-4009
Mailing Address - Country:US
Mailing Address - Phone:857-234-4639
Mailing Address - Fax:
Practice Address - Street 1:1302 COMMONWEALTH AVE APT 14
Practice Address - Street 2:
Practice Address - City:ALLSTON
Practice Address - State:MA
Practice Address - Zip Code:02134-4009
Practice Address - Country:US
Practice Address - Phone:857-234-4639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-28
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program