Provider Demographics
NPI:1902480494
Name:SADYKOV, VERONIKA (PA-C)
Entity Type:Individual
Prefix:
First Name:VERONIKA
Middle Name:
Last Name:SADYKOV
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1723 S WESTGATE AVE APT 8
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-3880
Mailing Address - Country:US
Mailing Address - Phone:510-646-7358
Mailing Address - Fax:
Practice Address - Street 1:1723 S WESTGATE AVE APT 8
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-3880
Practice Address - Country:US
Practice Address - Phone:510-646-7358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant