Healthcare Provider Details

I. General information

NPI: 1407667496
Provider Name (Legal Business Name): VIKTORIIA CHEREVENKO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2025
Last Update Date: 01/17/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 W PORTAL AVE
SAN FRANCISCO CA
94127-1412
US

IV. Provider business mailing address

324 W PORTAL AVE
SAN FRANCISCO CA
94127-1412
US

V. Phone/Fax

Practice location:
  • Phone: 415-731-8080
  • Fax: 415-681-6661
Mailing address:
  • Phone: 415-731-8080
  • Fax: 415-681-6661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License NumberL9712
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberL9712
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: