Provider Demographics
NPI:1528408473
Name:CHERNISHOF, IRINA (MD)
Entity Type:Individual
Prefix:
First Name:IRINA
Middle Name:
Last Name:CHERNISHOF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27107 TOURNEY RD
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-1860
Mailing Address - Country:US
Mailing Address - Phone:888-778-5000
Mailing Address - Fax:
Practice Address - Street 1:27107 TOURNEY RD
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91355-1860
Practice Address - Country:US
Practice Address - Phone:888-778-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-25
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA139722207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine