Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | T0171 | MD |
N | 208600000X | Surgeon | T0171 | MD |
N | 208G00000X | Cardiothoracic Vascular Surgeon | 036-124292 | IL |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 231930 | MA |
N | 208G00000X | Cardiothoracic Vascular Surgeon | 38964 | SC |
N | 208G00000X | Cardiothoracic Vascular Surgeon | ME142360 | FL |
NPI | 1124172135 |
---|---|
Provider Name | Christina Marcheva Vassileva |
First Address | Rockledge, FL 32955-4306 |
Second Address | Melbourne, FL 32901-3224 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2007 |
Last Update Date | 26/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036124292 | (05) | IL |
10073100 | (05) | FL |
110120533A | (05) | MA |
NP652 | FL MEDICARE (01) | FL |