Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 5305 | CA |
NPI | 1114361029 |
---|---|
Provider Name | Julia Vyacheslavovna Souvorova |
First Address | Chula Vista, CA 91910-2632 |
Second Address | Chula Vista, CA 91910-2632 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2013 |
Last Update Date | 19/10/2016 |