Healthcare Provider Details

I. General information

NPI: 1891958773
Provider Name (Legal Business Name): ANNA NAREZKINA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 02/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9434 MEDICAL CENTER DR
LA JOLLA CA
92037-1337
US

IV. Provider business mailing address

9300 CAMPUS POINT DRIVE MAIL CODE #7411
LA JOLLA CA
92037-7411
US

V. Phone/Fax

Practice location:
  • Phone: 858-657-8530
  • Fax:
Mailing address:
  • Phone: 858-657-8530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA113210
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: