Provider Demographics
NPI:1407951825
Name:CHETVERUKHIN, ALEKSEY (MD)
Entity Type:Individual
Prefix:MR
First Name:ALEKSEY
Middle Name:
Last Name:CHETVERUKHIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7531 SANTA MONICA BLVD
Mailing Address - Street 2:STE 210
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046-6458
Mailing Address - Country:US
Mailing Address - Phone:323-650-2991
Mailing Address - Fax:323-650-2993
Practice Address - Street 1:7531 SANTA MONICA BLVD
Practice Address - Street 2:STE 210
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046-6458
Practice Address - Country:US
Practice Address - Phone:323-650-2991
Practice Address - Fax:323-650-2993
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70079B2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry