Provider Demographics
NPI:1811349160
Name:MAKSIMOV, ALEKSEY
Entity type:Individual
Prefix:
First Name:ALEKSEY
Middle Name:
Last Name:MAKSIMOV
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 1:4757 PARKVIEW DR APT B
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-2426
Mailing Address - Country:US
Mailing Address - Phone:415-240-7712
Mailing Address - Fax:
Practice Address - Street 1:4757 PARKVIEW DR APT B
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-2426
Practice Address - Country:US
Practice Address - Phone:415-240-7712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201243205RN163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health