Healthcare Provider Details

I. General information

NPI: 1477932929
Provider Name (Legal Business Name): VIKTORIYA NEVEROV-KRSTIC L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2015
Last Update Date: 05/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

669 CRESPI DR SUITE A
PACIFICA CA
94044-3486
US

IV. Provider business mailing address

137 MONTECITO AVE APT 3
PACIFICA CA
94044-3486
US

V. Phone/Fax

Practice location:
  • Phone: 916-502-4092
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 16317
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: