Healthcare Provider Details

I. General information

NPI: 1649423310
Provider Name (Legal Business Name): NIKOLAY ALEKSEYENKO ACUPUNCTURIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 10/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 OUTLOOK CIR
PACIFICA CA
94044-2143
US

IV. Provider business mailing address

154 OUTLOOK CIR
PACIFICA CA
94044-2143
US

V. Phone/Fax

Practice location:
  • Phone: 650-738-1854
  • Fax:
Mailing address:
  • Phone: 650-738-1854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC12528
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: