Individual
ROSTISLAV V IZHEVSKIY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
12014 SE MILL PLAIN BLVD STE 120, VANCOUVER, WA 98684-4044
(503) 761-2110
Mailing address
3220 NE 148TH AVE, VANCOUVER, WA 98682-8376
(360) 852-2918
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA 60124536
WA
Other
Enumeration date
11/15/2012
Last updated
11/15/2012
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