Irina Bazavan, NP
Individual provider Active NPI Gerontology Nurse Practitioner · Novato, CA
NPI 1932129707 · NPPES record last updated Mar 7, 2023
Key facts
- NPI
- 1932129707
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Gerontology Nurse Practitioner 363LG0600X
- License
- 8749 (CA)
- Practice address
- 750 Grant Ave
Suite 150
Novato, CA 94945-7001 - Phone
- (415) 899-9800
- Fax
- (415) 899-9805
- NPI assigned
- Jul 21, 2006
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8749 | CA | MD | Gerontology Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gerihealthsolutions, Inc. | Gerontology | Past | Accepting new patients |
| Priest NP Services | Gerontology | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gerontology Nurse Practitioner | 363LG0600X | 8749 | CA | Yes |
Addresses
Primary practice location
750 Grant Ave
Suite 150
Novato, CA 94945-7001
Mailing address
750 Grant Ave
Suite 150
Novato, CA 94945-7001
Phone (415) 899-9800
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8749 | Other | CA | NP LICENCE |
| RN3855290 | Medicaid | CA | |
| 385529 | Other | CA | RN LICENSE |
Other providers in Novato, CA
- Michelle Baumgartner
- Bay Area Community Resources, Inc.
- Bay Area Community Resources, Inc.
- Bay Area Surgical Specialists, Inc a Medical Corporation
- Mark Burrell Bazalgette
- Jolaine Beal
- Ariel Beauhaire
- Joann Rupert Behm
- Bell and Ellenberg Marriage Counseling, Inc.
- Judith Bell
All providers in Novato, CA · Gerontology Nurse Practitioner in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 7, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.