Healthcare Provider Details

I. General information

NPI: 1861425332
Provider Name (Legal Business Name): EKATERINA VASSILENKO SEARCY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: EKATERINA VASSILENKO SEARCY MD

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 11/08/2021
Certification Date: 11/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 MAIN ST STE 5
RAMONA CA
92065-5244
US

IV. Provider business mailing address

650 N STATE ST
HEMET CA
92543-2960
US

V. Phone/Fax

Practice location:
  • Phone: 760-789-6389
  • Fax: 760-789-6389
Mailing address:
  • Phone: 951-791-3300
  • Fax: 951-791-3333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA055158
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: