Provider Demographics
NPI:1427592476
Name:TUMASYAN, YELENA (PA)
Entity Type:Individual
Prefix:
First Name:YELENA
Middle Name:
Last Name:TUMASYAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11136 ACAMA ST APT 311
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91602-3067
Mailing Address - Country:US
Mailing Address - Phone:516-603-1047
Mailing Address - Fax:
Practice Address - Street 1:11136 ACAMA ST APT 311
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91602-3067
Practice Address - Country:US
Practice Address - Phone:516-603-1047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-09
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53709363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant