Healthcare Provider Details

I. General information

NPI: 1316238850
Provider Name (Legal Business Name): PETER ALEXANDER LJUBENKOV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2011
Last Update Date: 08/16/2022
Certification Date: 08/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 NELSON RISING LN STE 190
SAN FRANCISCO CA
94143-0003
US

IV. Provider business mailing address

675 NELSON RISING LN STE 190
SAN FRANCISCO CA
94143-0003
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-2057
  • Fax:
Mailing address:
  • Phone: 415-353-2057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA124893
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: