Provider Demographics
NPI:1699701102
Name:BAGDASAROVA, YEVGENIYA (PA-C)
Entity type:Individual
Prefix:MS
First Name:YEVGENIYA
Middle Name:
Last Name:BAGDASAROVA
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 1:3248 E SHIELDS AVE
Mailing Address - Street 2:STE D
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-6915
Mailing Address - Country:US
Mailing Address - Phone:559-233-3343
Mailing Address - Fax:559-233-3350
Practice Address - Street 1:3248 E. SHIELDS AVE
Practice Address - Street 2:SUITE D
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726
Practice Address - Country:US
Practice Address - Phone:559-233-3343
Practice Address - Fax:559-233-3350
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15617363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PA15617Medicare ID - Type Unspecified