Individual
MRS. IVETA AGADZHANOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1341 N ESCONDIDO BLVD, ESCONDIDO, CA 92026-2507
(760) 317-9121
Mailing address
1508 MALLORCA DR, VISTA, CA 92081-5047
(760) 412-2300
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
95170880
CA
Other
Enumeration date
10/04/2019
Last updated
10/04/2019
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