Healthcare Provider Details

I. General information

NPI: 1508183468
Provider Name (Legal Business Name): NATALYA GOLOVANOV NP-C, ND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NATALYA GOLOVANOV NURSE PRACTITIONER

II. Dates (important events)

Enumeration Date: 04/30/2010
Last Update Date: 08/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 QUAIL CT OFC PARK102
WALNUT CREEK CA
94596-8701
US

IV. Provider business mailing address

43 QUAIL CT OFC PARK102
WALNUT CREEK CA
94596-8701
US

V. Phone/Fax

Practice location:
  • Phone: 925-695-3113
  • Fax: 925-695-0406
Mailing address:
  • Phone: 415-948-8999
  • Fax: 925-695-0406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND-124
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95003717
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: