Healthcare Provider Details

I. General information

NPI: 1679078117
Provider Name (Legal Business Name): ALEKSANDR KOVALSKIY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ALEKS KOVALSKIY MD

II. Dates (important events)

Enumeration Date: 03/27/2018
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 PIER VIEW WAY
OCEANSIDE CA
92054-2803
US

IV. Provider business mailing address

1000 VALE TERRACE DR
VISTA CA
92084-5218
US

V. Phone/Fax

Practice location:
  • Phone: 760-631-5000
  • Fax: 760-414-3892
Mailing address:
  • Phone: 844-308-5003
  • Fax: 760-414-3892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME162561
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number323047
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA173918
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2019-02207
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: