Provider Demographics
NPI:1508633488
Name:TERENTYEV, ANDRII (CMT, CST, MT)
Entity Type:Individual
Prefix:MR
First Name:ANDRII
Middle Name:
Last Name:TERENTYEV
Suffix:
Gender:M
Credentials:CMT, CST, MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82165 DOCTOR CARREON BLVD APT 3D1
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-5878
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:82165 DOCTOR CARREON BLVD APT 3D1
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-5878
Practice Address - Country:US
Practice Address - Phone:213-401-5905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95196225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist