Provider Demographics
NPI:1114498730
Name:KUTAFINA, YULIYA (PA-C)
Entity Type:Individual
Prefix:
First Name:YULIYA
Middle Name:
Last Name:KUTAFINA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5240 NE 6TH AVE APT 26H
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33334-3334
Mailing Address - Country:US
Mailing Address - Phone:407-454-4821
Mailing Address - Fax:
Practice Address - Street 1:15689 SOUTHERN BLVD UNIT 101
Practice Address - Street 2:
Practice Address - City:LOXAHATCHEE GROVES
Practice Address - State:FL
Practice Address - Zip Code:33470-9229
Practice Address - Country:US
Practice Address - Phone:561-614-1116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-07
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9111794363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant