Healthcare Provider Details

I. General information

NPI: 1902956881
Provider Name (Legal Business Name): ALEXANDER AVANESOV PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: SASHA AVANESOV PH.D.

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 BROADWAY ST
REDWOOD CITY CA
94063-4008
US

IV. Provider business mailing address

41 BROADWAY ST
REDWOOD CITY CA
94063-4008
US

V. Phone/Fax

Practice location:
  • Phone: 650-281-4072
  • Fax:
Mailing address:
  • Phone: 650-281-4072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License NumberPSY33518
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY33518
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: