Healthcare Provider Details

I. General information

NPI: 1336229657
Provider Name (Legal Business Name): YULIYA PETROVNA ROSTOVTSEVA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39400 PASEO PADRE PKWY
FREMONT CA
94538-2310
US

IV. Provider business mailing address

37147 LANYARD TER APT 312
FREMONT CA
94536-1991
US

V. Phone/Fax

Practice location:
  • Phone: 510-248-3000
  • Fax:
Mailing address:
  • Phone: 510-797-7321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA93627
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: