Provider Demographics
NPI:1154149250
Name:PAVLOVA, KSENIIA
Entity type:Individual
Prefix:
First Name:KSENIIA
Middle Name:
Last Name:PAVLOVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 BERGIN DR APT G
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-4852
Mailing Address - Country:US
Mailing Address - Phone:831-220-2031
Mailing Address - Fax:
Practice Address - Street 1:370 BERGIN DR APT G
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-4852
Practice Address - Country:US
Practice Address - Phone:831-220-2031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-28
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
No171R00000XOther Service ProvidersInterpreter
No172A00000XOther Service ProvidersDriver