Provider Demographics
NPI:1679118764
Name:ODEGOVA, POLINA
Entity type:Individual
Prefix:
First Name:POLINA
Middle Name:
Last Name:ODEGOVA
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 1:1889 N RICE AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-7986
Mailing Address - Country:US
Mailing Address - Phone:973-570-5512
Mailing Address - Fax:
Practice Address - Street 1:1889 N RICE AVE STE 102
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-7986
Practice Address - Country:US
Practice Address - Phone:973-570-5512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-12
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist