Irina P Adamovich

Individual provider Active NPI Driver · Sacramento, CA

NPI 1821592940 · NPPES record last updated Jun 16, 2018

Key facts

NPI
1821592940
Entity type
Individual (NPI type 1)
Primary specialty
Driver 172A00000X
License
D4440855 (CA)
Practice address
3900 Annadale LN Apt 40
Sacramento, CA 95821-2030
Phone
(916) 505-4774
NPI assigned
Mar 22, 2018
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
D4440855CAMDDriver

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Driver
Group: 193400000X SINGLE SPECIALTY GROUP
172A00000X D4440855 CA Yes

Addresses

Primary practice location

3900 Annadale LN Apt 40
Sacramento, CA 95821-2030

Mailing address

3900 Annadale LN Apt 40
Sacramento, CA 95821-2030
Phone (916) 505-4774

Other identifiers

IdentifierTypeStateIssuer
11572585OtherCAKAISER PERMANENTE

Other providers in Sacramento, CA

All providers in Sacramento, CA · Driver in California

Sources for this page

Verify at the official NPI Registry.