Provider Demographics
NPI:1669289740
Name:BELJAEV, DAVID SISAK
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:SISAK
Last Name:BELJAEV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8107 WHITNEY DR
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92509-5209
Mailing Address - Country:US
Mailing Address - Phone:818-434-1753
Mailing Address - Fax:
Practice Address - Street 1:8107 WHITNEY DR
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92509-5209
Practice Address - Country:US
Practice Address - Phone:818-434-1753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent