Healthcare Provider Details

I. General information

NPI: 1053530618
Provider Name (Legal Business Name): GALINA ROVENSKY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7646 DENSMORE AVE
VAN NUYS CA
91406-2042
US

IV. Provider business mailing address

7139 COLDWATER CANYON AVE APT13
NORTH HOLLYWOOD CA
91605-4969
US

V. Phone/Fax

Practice location:
  • Phone: 818-994-0804
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN524805
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: