Provider Demographics
NPI:1386770691
Name:SOFYA TSYGANOVSKAYA MD INC.
Entity type:Organization
Organization Name:SOFYA TSYGANOVSKAYA MD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SOFYA
Authorized Official - Middle Name:
Authorized Official - Last Name:TSYAGANOVSKAYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-653-7931
Mailing Address - Street 1:PO BOX 5655
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91221-5655
Mailing Address - Country:US
Mailing Address - Phone:818-559-7367
Mailing Address - Fax:818-843-4622
Practice Address - Street 1:1411 W OLIVE AVE
Practice Address - Street 2:SUITE D&E
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-2427
Practice Address - Country:US
Practice Address - Phone:818-843-1884
Practice Address - Fax:818-843-4622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA84551174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A845510Medicaid