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Individual
ANDREY IVANOVICH SIDORENKO
Active
Individual
ANDREY IVANOVICH SIDORENKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C, DMSC
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
21131
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CA109622
PREMIUM URGENT CARE GRP PTAN
CA
Enumeration date
08/25/2010
Last updated
06/30/2025
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