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General NPI Number Information
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NPI Number | 1043672462
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Entity Type | Individual
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Provider Name | DR. ALEKSEY ZAKINOV
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Gender | Male
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Dates
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Enumeration Date | 03/24/2016
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 3900 LAKEVILLE HWY
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City | PETALUMA
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State | CA
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Zip | 94954-5698
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Country | US
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Telephone | 707-765-3960
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Fax |
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Provider Business Mailing Address
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Address Line | 240 MEETING HOUSE LN
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City | SOUTHAMPTON
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State | NY
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Zip | 11968-5009
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A162874
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License Number State | CA
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