1225317449 NPI number — ALEKSANDRA STEPANENKO SOYKIN PH.D.

Table of content: ALEKSANDRA STEPANENKO SOYKIN PH.D. (NPI 1225317449)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225317449 NPI number — ALEKSANDRA STEPANENKO SOYKIN PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOYKIN
Provider First Name:
ALEKSANDRA
Provider Middle Name:
STEPANENKO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STEPANENKO
Provider Other First Name:
ALEKSANDRA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PH.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1225317449
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/05/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
801 TRAEGER AVE FL 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN BRUNO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94066-3045
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-742-7242
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 TRAEGER AVE FL 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN BRUNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94066-3045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-742-7242
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/04/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  27597 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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