Healthcare Provider Details

I. General information

NPI: 1811340466
Provider Name (Legal Business Name): NINA IVANOVA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2016
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 EL CAMINO REAL APT 2
BURLINGAME CA
94010-5139
US

IV. Provider business mailing address

516 EL CAMINO REAL APT 2
BURLINGAME CA
94010-5139
US

V. Phone/Fax

Practice location:
  • Phone: 650-438-7757
  • Fax:
Mailing address:
  • Phone: 650-438-7757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN95178511
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: