Provider Demographics
NPI:1467129049
Name:RODIONOFF, VICTOR IAN (NP, PMHNP-BC)
Entity Type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:IAN
Last Name:RODIONOFF
Suffix:
Gender:M
Credentials:NP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 21ST AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94121-2142
Mailing Address - Country:US
Mailing Address - Phone:650-703-8905
Mailing Address - Fax:
Practice Address - Street 1:229 21ST AVE APT 6
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94121-2142
Practice Address - Country:US
Practice Address - Phone:650-703-8905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-23
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
CA95166305163WC0200X
CA95021917363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine