Healthcare Provider Details

I. General information

NPI: 1669960720
Provider Name (Legal Business Name): ALEKSEY SHARIPOV PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2018
Last Update Date: 09/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5709 MARCONI AVE STE E
CARMICHAEL CA
95608-4585
US

IV. Provider business mailing address

6930 FAIR OAKS BLVD APT 195
CARMICHAEL CA
95608-3381
US

V. Phone/Fax

Practice location:
  • Phone: 916-606-3355
  • Fax:
Mailing address:
  • Phone: 916-606-3355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY29881
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: