Provider Demographics
NPI:1730966417
Name:ALESHIN, SERGEY (FNP)
Entity type:Individual
Prefix:
First Name:SERGEY
Middle Name:
Last Name:ALESHIN
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12488 MONTE VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-2359
Mailing Address - Country:US
Mailing Address - Phone:132-370-6743
Mailing Address - Fax:
Practice Address - Street 1:5419 HOLLYWOOD BLVD # C129
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-3480
Practice Address - Country:US
Practice Address - Phone:323-706-7438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95026273363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily