Provider Demographics
NPI:1356801658
Name:VANEGAS, IELYZAVETA ROMANOVA (MD)
Entity type:Individual
Prefix:
First Name:IELYZAVETA
Middle Name:ROMANOVA
Last Name:VANEGAS
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:PO BOX 580
Mailing Address - Street 2:
Mailing Address - City:LEMOORE
Mailing Address - State:CA
Mailing Address - Zip Code:93245-0580
Mailing Address - Country:US
Mailing Address - Phone:559-538-4500
Mailing Address - Fax:
Practice Address - Street 1:209 C ST
Practice Address - Street 2:
Practice Address - City:LEMOORE
Practice Address - State:CA
Practice Address - Zip Code:93245-2930
Practice Address - Country:US
Practice Address - Phone:559-924-7005
Practice Address - Fax:559-925-8500
Is Sole Proprietor?:No
Enumeration Date:2019-03-22
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA180067207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine