Provider Demographics
NPI:1891333043
Name:SHOPSKI, BLAGOVEST G (NP)
Entity type:Individual
Prefix:
First Name:BLAGOVEST
Middle Name:G
Last Name:SHOPSKI
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1935 ALPHA RD UNIT 232
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-2139
Mailing Address - Country:US
Mailing Address - Phone:310-666-3791
Mailing Address - Fax:
Practice Address - Street 1:1935 ALPHA RD UNIT 232
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-2139
Practice Address - Country:US
Practice Address - Phone:310-666-3791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-18
Last Update Date:2025-01-10
Deactivation Date:2021-03-08
Deactivation Code:
Reactivation Date:2025-01-09
Provider Licenses
StateLicense IDTaxonomies
CA95031585363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner