Provider Demographics
NPI:1013230945
Name:BACHAYEV, ALEKSANDR (SURGICAL ASSISTANT)
Entity Type:Individual
Prefix:
First Name:ALEKSANDR
Middle Name:
Last Name:BACHAYEV
Suffix:
Gender:M
Credentials:SURGICAL ASSISTANT
Other - Prefix:
Other - First Name:SASHA
Other - Middle Name:
Other - Last Name:BACHAYEV
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SURGICAL ASSISTANT
Mailing Address - Street 1:6565 E EXPOSITION AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224-1504
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6565 E EXPOSITION AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80224-1504
Practice Address - Country:US
Practice Address - Phone:303-901-0870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-06
Last Update Date:2014-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO09-316261QA1903X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No282N00000XHospitalsGeneral Acute Care Hospital