Provider Demographics
NPI:1629260971
Name:ROZOVA, ALLA P (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ALLA
Middle Name:P
Last Name:ROZOVA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALLA
Other - Middle Name:P
Other - Last Name:NOVOSELTSEVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:15425 LOS GATOS BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-2541
Mailing Address - Country:US
Mailing Address - Phone:408-354-3920
Mailing Address - Fax:
Practice Address - Street 1:15425 LOS GATOS BLVD STE 120
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2541
Practice Address - Country:US
Practice Address - Phone:408-354-3920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-10
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19073363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant