Provider Demographics
NPI:1699504647
Name:NARSAVIDZE, ALESSA
Entity type:Individual
Prefix:
First Name:ALESSA
Middle Name:
Last Name:NARSAVIDZE
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 1:7909 WALERGA RD STE 112
Mailing Address - Street 2:
Mailing Address - City:ANTELOPE
Mailing Address - State:CA
Mailing Address - Zip Code:95843-5727
Mailing Address - Country:US
Mailing Address - Phone:916-217-3390
Mailing Address - Fax:
Practice Address - Street 1:8020 WALERGA RD UNIT 1184
Practice Address - Street 2:
Practice Address - City:ANTELOPE
Practice Address - State:CA
Practice Address - Zip Code:95843-5784
Practice Address - Country:US
Practice Address - Phone:916-217-3390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach