Individual
IVANA ANGELIEVA RADEVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
18321 CLARK ST, TARZANA, CA 91356-3501
(818) 708-5285
Mailing address
220 BAY ST APT 213, SANTA MONICA, CA 90405-1029
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
A123727
CA
Other
Enumeration date
04/05/2011
Last updated
05/20/2016
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