Provider Demographics
NPI:1023096443
Name:KRAKOVSKY, ALEXANDER A (MD)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:A
Last Name:KRAKOVSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7946 IVANHOE AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-4516
Mailing Address - Country:US
Mailing Address - Phone:858-551-9500
Mailing Address - Fax:858-551-9503
Practice Address - Street 1:7946 IVANHOE AVE STE 106
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-4516
Practice Address - Country:US
Practice Address - Phone:858-551-9500
Practice Address - Fax:858-551-9503
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA81711174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH85906Medicare UPIN
CAWA1711BMedicare ID - Type Unspecified