Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | A112836 | CA |
NPI | 1003063488 |
---|---|
Provider Name | Anna Mikhailovsky |
First Address | Ventura, CA 93003-3099 |
Second Address | Ventura, CA 93003-3099 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2008 |
Last Update Date | 23/08/2011 |