Doctor Name: | ROSTISLAV V IZHEVSKIY |
NPI Number: | 1174867030 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | MA 60124536 |
Business Practice Address: | 12014 Se Mill Plain Blvd Ste 120 Vancouver, WA - 986844044 |
Business Phone Number: | 5037612110 |
Business Fax Number: | |
Mailing Address: | 3220 Ne 148th Ave, VANCOUVER |
State: | WA |
Postal Code: | 986828376 |
Phone Number: | 3608522918 |
Fax Number: | |
NPI Enumeration Date: | 11/15/2012 |
NPI Last Update Date: | 11/15/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | MA 60124536 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |