Provider Demographics
NPI:1013672385
Name:TCHERNOGOROVA, MARIA-MAGDALENA NIKOLAEVA (DC)
Entity Type:Individual
Prefix:
First Name:MARIA-MAGDALENA
Middle Name:NIKOLAEVA
Last Name:TCHERNOGOROVA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13914 BORA BORA WAY APT 122
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-6837
Mailing Address - Country:US
Mailing Address - Phone:702-403-3607
Mailing Address - Fax:
Practice Address - Street 1:8472 MELROSE PL
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90069-5308
Practice Address - Country:US
Practice Address - Phone:702-403-3607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC35082111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor