Provider Demographics
NPI:1770902272
Name:SERGEEVA, EKATERINA (DPM)
Entity type:Individual
Prefix:
First Name:EKATERINA
Middle Name:
Last Name:SERGEEVA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:MRS
Other - First Name:EKATERINA
Other - Middle Name:
Other - Last Name:STARKEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2604B EL CAMINO REAL STE 311
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-1214
Mailing Address - Country:US
Mailing Address - Phone:760-580-6733
Mailing Address - Fax:442-224-7956
Practice Address - Street 1:1512 GREEN OAK RD
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-8740
Practice Address - Country:US
Practice Address - Phone:760-580-6733
Practice Address - Fax:442-224-7956
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-11
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5390213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine