Anastasia P Dertlieva-Popova, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA21114 Issued in CA

Practice address

2575 E Bidwell St
Suite 230
Folsom, CA 95630-6444

Phone

(916) 984-3899

NPI assigned

Sep 22, 2010

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Physician Assistant

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1285113600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1285113600000",
    "number": "1891003943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 34120",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895334120",
            "telephone_number": "775-747-5050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2575 E BIDWELL ST",
            "address_2": "SUITE 230",
            "city": "FOLSOM",
            "state": "CA",
            "postal_code": "956306444",
            "telephone_number": "916-984-3899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERTLIEVA-POPOVA",
        "first_name": "ANASTASIA",
        "middle_name": "P",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-09-22",
        "last_updated": "2010-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA21114",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael D Dennis, PA-C
• Dental Anatomy
• Anthony Philip Depalma, SUDRC I
• Rachel Derby, AMFT
• Evelyn Deroos
• Melissa Deryk
• Vaishali Desai, M.D.
• Taylor K Desilva
• Destiny Health Clinic LLC
• Annika Elizabeth Dethlefs, FNP-BC

• Physician Assistant in Folsom, CA
• Providers in Folsom, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.