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General NPI Number Information
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NPI Number | 1134530314
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Entity Type | Organization
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Legal Business Name | OLGA IAROSSEVITCH LLC
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Dates
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Enumeration Date | 05/09/2014
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Last Update Date | 05/09/2014
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Provider Practice Location Address
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Address Line | 2090 S CONFERENCE DR
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City | BOCA RATON
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State | FL
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Zip | 33486-3114
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Country | US
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Telephone | 561-271-4338
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Fax |
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Provider Business Mailing Address
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Address Line | 105 E PALMETTO PARK RD B
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City | BOCA RATON
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State | FL
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Zip | 33432-4801
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Country | US
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Telephone | 561-271-4338
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | OLGA IAROSSEVITCH
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Credential |
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Telephone | 561-271-4338
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA9104365
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License Number State | FL
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