Provider Demographics
NPI:1356797476
Name:RAZINKOVA, EVGUENIA
Entity type:Individual
Prefix:
First Name:EVGUENIA
Middle Name:
Last Name:RAZINKOVA
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 1:1848 SARATOGA AVE
Mailing Address - Street 2:5A
Mailing Address - City:SARATOGA
Mailing Address - State:CA
Mailing Address - Zip Code:95070-6612
Mailing Address - Country:US
Mailing Address - Phone:408-691-7999
Mailing Address - Fax:
Practice Address - Street 1:1848 SARATOGA AVE
Practice Address - Street 2:5A
Practice Address - City:SARATOGA
Practice Address - State:CA
Practice Address - Zip Code:95070-6612
Practice Address - Country:US
Practice Address - Phone:408-691-7999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-07
Last Update Date:2016-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52914225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist