Provider Demographics
NPI:1508294083
Name:SILVERLINING PSYCHIATRY MEDICAL GROUP
Entity Type:Organization
Organization Name:SILVERLINING PSYCHIATRY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DMITRIY
Authorized Official - Middle Name:
Authorized Official - Last Name:SIVTSOV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-230-7585
Mailing Address - Street 1:2250 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-2024
Mailing Address - Country:US
Mailing Address - Phone:858-230-7585
Mailing Address - Fax:858-658-0857
Practice Address - Street 1:2250 3RD AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-2024
Practice Address - Country:US
Practice Address - Phone:858-230-7585
Practice Address - Fax:858-658-0857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-21
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA88348103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Single Specialty