Provider Demographics
NPI:1578734323
Name:VAKULENKO, MARTA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTA
Middle Name:
Last Name:VAKULENKO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4867 W SUNSET BLVD FL 3
Mailing Address - Street 2:CARDIAC ELECTROPHYSIOLOGY LAB
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-5969
Mailing Address - Country:US
Mailing Address - Phone:323-783-5850
Mailing Address - Fax:818-638-7799
Practice Address - Street 1:4867 W SUNSET BLVD FL 3
Practice Address - Street 2:CARDIAC ELECTROPHYSIOLOGY LAB
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-5969
Practice Address - Country:US
Practice Address - Phone:323-783-5850
Practice Address - Fax:818-638-7799
Is Sole Proprietor?:No
Enumeration Date:2008-03-20
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA97039207R00000X, 207RC0001X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology