# IRINA BAZAVAN

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1932129707
- **Gender:** F
- **Credential:** NP

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LG0600X | Gerontology Nurse Practitioner | 8749 | CA | Yes |

## Other

- **Enumeration date:** 07/21/2006
- **Last updated:** 03/07/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 385529 | RN LICENSE | CA |
| 01 | — | 8749 | NP LICENCE | CA |
| 05 | — | RN3855290 | — | CA |