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NPI Code Detail

MEDICARE: WALESKA MIKAR GONTSCHARENKO SA-C

MEDICARE:   WALESKA MIKAR GONTSCHARENKO  SA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1246ZC0007XSurgical Assistant21-113TX

General Provider Information

NPI Number : 1538746169
Entity Type Code : Individual
Provider Name (Legal Business Name) : WALESKA MIKAR GONTSCHARENKO SA-C
Provider Business Mailing Address
First Line : 8900 RED BLUFF RD APT 2633
Second Line :
City : PASADENA
State : TX
Zip : 77507-1152
Country : US
Telephone Number : 917-514-3296
Fax Number :
Provider Business Practice Location Address
First Line : 8900 RED BLUFF RD APT 2633
Second Line :
City : PASADENA
State : TX
Zip : 77507-1152
Country : US
Telephone Number : 917-514-3296
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/28/2021
Last Update Date : 03/28/2021

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Directions to “ WALESKA MIKAR GONTSCHARENKO SA-C” Practice Location

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