Provider Demographics
NPI:1669115846
Name:TSVEROV, MARIANA (MS, CF-SLP)
Entity type:Individual
Prefix:
First Name:MARIANA
Middle Name:
Last Name:TSVEROV
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3858 GREEN ACRES LN
Mailing Address - Street 2:
Mailing Address - City:LOOMIS
Mailing Address - State:CA
Mailing Address - Zip Code:95650-9759
Mailing Address - Country:US
Mailing Address - Phone:916-751-6314
Mailing Address - Fax:
Practice Address - Street 1:6508 LONETREE BLVD STE 104
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-5885
Practice Address - Country:US
Practice Address - Phone:916-287-1914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-15
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16613235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist