Provider Demographics
NPI:1518997212
Name:CHETVER, ELENA V (MD)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:CHETVER
Suffix:V
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7531 SANTA MONICA BLVD, 210
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046-6400
Mailing Address - Country:US
Mailing Address - Phone:323-650-2991
Mailing Address - Fax:323-650-2993
Practice Address - Street 1:7531 SANTA MONICA BLVD, 210
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046-6400
Practice Address - Country:US
Practice Address - Phone:323-650-2991
Practice Address - Fax:323-650-2993
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52741207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A527410Medicaid
CAG20683Medicare UPIN
CAA52741Medicare ID - Type Unspecified