Provider Demographics
NPI:1801511365
Name:PAVLOVICH, NATASHA
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:PAVLOVICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TASHA
Other - Middle Name:
Other - Last Name:PAVLOVICH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:TASHA PAVLOVICH
Mailing Address - Street 1:1727 ANTIGUA WAY
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-4347
Mailing Address - Country:US
Mailing Address - Phone:949-542-9012
Mailing Address - Fax:
Practice Address - Street 1:1727 ANTIGUA WAY
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-4347
Practice Address - Country:US
Practice Address - Phone:949-542-9012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach