Provider Demographics
NPI:1649329681
Name:SMIRNOFF, ALEX VICTOR (MD)
Entity type:Individual
Prefix:DR
First Name:ALEX
Middle Name:VICTOR
Last Name:SMIRNOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1655 N MAIN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-4679
Mailing Address - Country:US
Mailing Address - Phone:925-395-6504
Mailing Address - Fax:925-943-4904
Practice Address - Street 1:1655 N MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-4679
Practice Address - Country:US
Practice Address - Phone:925-395-6504
Practice Address - Fax:925-943-4904
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2016-01-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA872932084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry