Individual
IRINA BORTNOVSKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5228 COPPER RIDGE WAY, ANTELOPE, CA 95843-5984
(916) 761-0454
Mailing address
7273 14TH AVE STE 120B, SACRAMENTO, CA 95820-3500
(916) 383-6783
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
663089
CA
Other
Enumeration date
12/03/2019
Last updated
12/03/2019
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