Provider Demographics
NPI:1396869715
Name:ATANASSOVA, NINA ILIEVA
Entity type:Individual
Prefix:
First Name:NINA
Middle Name:ILIEVA
Last Name:ATANASSOVA
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 1:1250 OAKMEAD PKWY
Mailing Address - Street 2:SUITE # 210
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94085-4027
Mailing Address - Country:US
Mailing Address - Phone:408-832-7365
Mailing Address - Fax:509-267-1472
Practice Address - Street 1:1250 OAKMEAD PKWY
Practice Address - Street 2:SUITE # 210
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94085-4027
Practice Address - Country:US
Practice Address - Phone:408-832-7365
Practice Address - Fax:509-267-1472
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47465106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist