Provider Demographics
NPI:1104837426
Name:DEMENKO, ALEKSANDRIYA S (MD)
Entity Type:Individual
Prefix:
First Name:ALEKSANDRIYA
Middle Name:S
Last Name:DEMENKO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10790 RANCHO BERNARDO RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-5705
Mailing Address - Country:US
Mailing Address - Phone:858-554-9800
Mailing Address - Fax:
Practice Address - Street 1:380 STEVENS AVE STE 100
Practice Address - Street 2:
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-2068
Practice Address - Country:US
Practice Address - Phone:858-554-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA119922207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200908310Medicaid
IN000000595572OtherANTHEM
INP006984444OtherRAILROAD MEDICARE
IN000000595572OtherANTHEM
IN048580N9Medicare PIN