Provider Demographics
NPI:1538968680
Name:EGOROVA, KSENIA
Entity type:Individual
Prefix:MRS
First Name:KSENIA
Middle Name:
Last Name:EGOROVA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:886 S 10TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-2433
Mailing Address - Country:US
Mailing Address - Phone:415-465-0496
Mailing Address - Fax:
Practice Address - Street 1:886 S 10TH ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-2433
Practice Address - Country:US
Practice Address - Phone:415-465-0496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA434416322374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula