Provider Demographics
NPI:1134628621
Name:IVELIA, VERONICA SEZANOV
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:SEZANOV
Last Name:IVELIA
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 1:9171 BROWNING DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-5247
Mailing Address - Country:US
Mailing Address - Phone:714-906-2182
Mailing Address - Fax:
Practice Address - Street 1:9171 BROWNING DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92646-5247
Practice Address - Country:US
Practice Address - Phone:714-906-2182
Practice Address - Fax:714-906-2182
Is Sole Proprietor?:No
Enumeration Date:2018-02-09
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95008462363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily