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General NPI Number Information
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NPI Number | 1265256176
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Entity Type | Organization
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Legal Business Name | SERGEY SERGEYEVICH PROGUSHEV MD INC
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Dates
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Enumeration Date | 11/08/2024
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Last Update Date | 11/08/2024
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Provider Practice Location Address
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Address Line | 18330 ROSCOE BLVD
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City | NORTHRIDGE
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State | CA
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Zip | 91325-4105
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Country | US
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Telephone | 747-224-4004
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Fax |
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Provider Business Mailing Address
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Address Line | 686 MONTEREY PL
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City | SIERRA MADRE
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State | CA
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Zip | 91024-2105
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Country | US
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Telephone | 912-658-1150
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SERGEY SERGEYEVICH PROGUSHEV
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Credential | MD
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Telephone | 912-658-1150
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207LC0200X
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Taxonomy Name | Critical Care Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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