Healthcare Provider Details

I. General information

NPI: 1699701102
Provider Name (Legal Business Name): YEVGENIYA BAGDASAROVA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 01/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3248 E. SHIELDS AVE SUITE D
FRESNO CA
93726
US

IV. Provider business mailing address

3248 E SHIELDS AVE STE D
FRESNO CA
93726-6915
US

V. Phone/Fax

Practice location:
  • Phone: 559-233-3343
  • Fax: 559-233-3350
Mailing address:
  • Phone: 559-233-3343
  • Fax: 559-233-3350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number15617
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: