Individual provider Active NPI

Aleksandr V Demenko, MD

  • Family Medicine Physician
  • Escondido, CA
National Provider Identifier
1073740007
Registry record updated Jan 13, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A119839 Issued in CA
Practice address
488 E Valley Pkwy
Escondido, CA 92025-3363
Phone
(760) 806-5700
NPI assigned
Jun 17, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A119839 CA Primary

Addresses

Primary practice location

488 E Valley Pkwy
Escondido, CA 92025-3363

Mailing address

10170 Sorrento Valley Rd
San Diego, CA 92121-1604
Phone (858) 784-5888

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1245196800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1358035200000",
    "number": "1073740007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10170 SORRENTO VALLEY RD",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921211604",
            "telephone_number": "858-784-5888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "488 E VALLEY PKWY",
            "city": "ESCONDIDO",
            "state": "CA",
            "postal_code": "920253363",
            "telephone_number": "760-806-5700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEMENKO",
        "first_name": "ALEKSANDR",
        "middle_name": "V",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-17",
        "last_updated": "2013-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A119839",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Escondido, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.