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NPI Code Detail

MEDICARE: DMITRIY SIVTSOV MD

MEDICARE: DMITRIY SIVTSOV MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry PhysicianA88348CA

General Provider Information

NPI Number : 1467553958
Entity Type Code : Individual
Provider Name (Legal Business Name) : DMITRIY SIVTSOV MD
Provider Business Mailing Address
First Line : 2250 3RD AVE
Second Line :
City : SAN DIEGO
State : CA
Zip : 92101-2024
Country : US
Telephone Number : 858-230-7585
Fax Number : 858-658-0857
Provider Business Practice Location Address
First Line : 2250 3RD AVE
Second Line :
City : SAN DIEGO
State : CA
Zip : 92101-2024
Country : US
Telephone Number : 858-230-7585
Fax Number : 858-658-0857
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/26/2006
Last Update Date : 03/13/2024

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Directions to “ DMITRIY SIVTSOV MD” Practice Location

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