Individual
IRINA BAZAVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
750 GRANT AVE, SUITE 150, NOVATO, CA 94945-7001
(415) 899-9800
(415) 899-9805
Mailing address
750 GRANT AVE, SUITE 150, NOVATO, CA 94945-7001
(415) 899-9800
(415) 899-9805
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
8749
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
385529
RN LICENSE
CA
01
—
8749
NP LICENCE
CA
05
—
RN3855290
—
CA
Enumeration date
07/21/2006
Last updated
03/07/2023
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