Provider Demographics
NPI:1336123546
Name:BRESNITZ, SVETLANA (MD)
Entity Type:Individual
Prefix:DR
First Name:SVETLANA
Middle Name:
Last Name:BRESNITZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SVETLANA
Other - Middle Name:
Other - Last Name:BLASKOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:106 BLANCA AVE
Mailing Address - Street 2:
Mailing Address - City:ALAMOSA
Mailing Address - State:CO
Mailing Address - Zip Code:81101-2340
Mailing Address - Country:US
Mailing Address - Phone:719-589-8004
Mailing Address - Fax:719-587-6287
Practice Address - Street 1:106 BLANCA AVE
Practice Address - Street 2:
Practice Address - City:ALAMOSA
Practice Address - State:CO
Practice Address - Zip Code:81101-2340
Practice Address - Country:US
Practice Address - Phone:719-589-8004
Practice Address - Fax:719-587-6287
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO43761208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO840255530037OtherROCKY MTN HEALTH PLANS
CO09334751Medicaid
CO840255530037OtherROCKY MTN HEALTH PLANS
COI68494Medicare UPIN