Provider Demographics
NPI:1972304541
Name:OVEZLIYEVA, AYGUL
Entity type:Individual
Prefix:
First Name:AYGUL
Middle Name:
Last Name:OVEZLIYEVA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27746 KRISTIN LN
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91350-4327
Mailing Address - Country:US
Mailing Address - Phone:661-373-9720
Mailing Address - Fax:
Practice Address - Street 1:1321 E COLORADO ST STE M
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-4003
Practice Address - Country:US
Practice Address - Phone:661-373-9720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-20
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95031306363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner