Individual
ANDREY IVANOVICH SIDORENKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C, DMSC
Contact information
Practice address
2615 E CLINTON AVE, FRESNO, CA 93703-2223
(559) 225-6100
Mailing address
CMR 467 BOX 5991, APO, AE 09096-1060
(559) 709-1344
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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