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General NPI Number Information
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NPI Number | 1417999038
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Entity Type | Individual
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Provider Name | IRINA A VASILYEVA MD PHD
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Gender | Female
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Dates
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Enumeration Date | 06/11/2006
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Last Update Date | 09/29/2017
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Provider Practice Location Address
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Address Line | 1001 POTRERO AVE RM 1X55
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City | SAN FRANCISCO
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State | CA
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Zip | 94110-3518
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Country | US
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Telephone | 415-206-5871
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Fax | 415-206-4004
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Provider Business Mailing Address
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Address Line | 250 GORGE RD #8C
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City | CLIFFSIDE PARK
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State | NJ
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Zip | 07010
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Country | US
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Telephone | 201-724-8178
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Fax | 201-917-3447
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 245445
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License Number State | NY
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