Provider Demographics
NPI:1104363977
Name:ASHKINAZI, OLEG
Entity Type:Individual
Prefix:
First Name:OLEG
Middle Name:
Last Name:ASHKINAZI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7942 ELECTRA DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046-2012
Mailing Address - Country:US
Mailing Address - Phone:323-428-2522
Mailing Address - Fax:
Practice Address - Street 1:7942 ELECTRA DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90046-2012
Practice Address - Country:US
Practice Address - Phone:323-428-2522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT3315283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital