Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 19307 | CA |
NPI | 1033442165 |
---|---|
Provider Name | Cynthia Jovanov |
First Address | Riverside, CA 92501-4028 |
Second Address | Santa Rosa, CA 95405-4801 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2009 |
Last Update Date | 01/02/2021 |