Provider Demographics
NPI:1437574985
Name:SKVOLYGIN, MIKHAIL (RCP, RRT)
Entity Type:Individual
Prefix:
First Name:MIKHAIL
Middle Name:
Last Name:SKVOLYGIN
Suffix:
Gender:M
Credentials:RCP, RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5580 LAKE PARK WAY # 20
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-4253
Mailing Address - Country:US
Mailing Address - Phone:619-928-1113
Mailing Address - Fax:
Practice Address - Street 1:5580 LAKE PARK WAY # 20
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-4253
Practice Address - Country:US
Practice Address - Phone:619-928-1113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-20
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32720227900000X, 2279H0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered
No2279H0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredHome Health