Healthcare Provider Details

I. General information

NPI: 1376830455
Provider Name (Legal Business Name): VERONICA RATEVOSIAN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2011
Last Update Date: 07/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9400 BRIGHTON WAY STE 410
BEVERLY HILLS CA
90210-4711
US

IV. Provider business mailing address

9400 BRIGHTON WAY STE 410
BEVERLY HILLS CA
90210-4711
US

V. Phone/Fax

Practice location:
  • Phone: 319-256-2426
  • Fax:
Mailing address:
  • Phone: 818-427-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA21627
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: