Healthcare Provider Details

I. General information

NPI: 1689578429
Provider Name (Legal Business Name): ACNP HEALTHCARE SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11539 SANTINI LN
PORTER RANCH CA
91326-4421
US

IV. Provider business mailing address

11539 SANTINI LN
PORTER RANCH CA
91326-4421
US

V. Phone/Fax

Practice location:
  • Phone: 818-636-9344
  • Fax: 818-483-8104
Mailing address:
  • Phone: 818-636-9344
  • Fax: 818-483-8104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: DMITRIY TRETIAK
Title or Position: PRESIDENT
Credential: NP
Phone: 818-636-9344