Provider Demographics
NPI:1083199541
Name:ZHURGENOV, YELDAR (MA)
Entity Type:Individual
Prefix:
First Name:YELDAR
Middle Name:
Last Name:ZHURGENOV
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:988 HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-4183
Mailing Address - Country:US
Mailing Address - Phone:415-975-0908
Mailing Address - Fax:415-975-9932
Practice Address - Street 1:988 HOWARD ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-4183
Practice Address - Country:US
Practice Address - Phone:415-975-0908
Practice Address - Fax:415-975-9932
Is Sole Proprietor?:No
Enumeration Date:2018-10-01
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT109597106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist