Provider Demographics
NPI:1336318534
Name:ROVENSKY, MIKHAIL YAKOV
Entity Type:Individual
Prefix:DR
First Name:MIKHAIL
Middle Name:YAKOV
Last Name:ROVENSKY
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 1:7601 CANBY AVE
Mailing Address - Street 2:SUITE7
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-2953
Mailing Address - Country:US
Mailing Address - Phone:818-757-1919
Mailing Address - Fax:818-757-3134
Practice Address - Street 1:9301 WILSHIRE BLVD STE 404
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-6137
Practice Address - Country:US
Practice Address - Phone:310-278-9171
Practice Address - Fax:310-278-2058
Is Sole Proprietor?:No
Enumeration Date:2008-02-21
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25499111N00000X
CA797635163W00000X
CA95003854363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No111N00000XChiropractic ProvidersChiropractor
No163W00000XNursing Service ProvidersRegistered Nurse