Healthcare Provider Details

I. General information

NPI: 1336318534
Provider Name (Legal Business Name): DR. MIKHAIL YAKOV ROVENSKY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2008
Last Update Date: 10/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9301 WILSHIRE BLVD STE 404
BEVERLY HILLS CA
90210-6137
US

IV. Provider business mailing address

7601 CANBY AVE SUITE7
RESEDA CA
91335-2953
US

V. Phone/Fax

Practice location:
  • Phone: 310-278-9171
  • Fax: 310-278-2058
Mailing address:
  • Phone: 818-757-1919
  • Fax: 818-757-3134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC25499
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number797635
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95003854
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: