Provider Demographics
NPI:1740478502
Name:VALERY D. TARASENKO, MD, INC.
Entity type:Organization
Organization Name:VALERY D. TARASENKO, MD, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:VALERY
Authorized Official - Middle Name:D
Authorized Official - Last Name:TARASENKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-359-2255
Mailing Address - Street 1:200 BUTCHER RD
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-5616
Mailing Address - Country:US
Mailing Address - Phone:707-359-2255
Mailing Address - Fax:707-359-2259
Practice Address - Street 1:200 BUTCHER RD
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-5616
Practice Address - Country:US
Practice Address - Phone:707-359-2255
Practice Address - Fax:707-359-2259
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED PAIN MANAGEMENT INSTITUTE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-05
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ29887ZMedicare PIN