Provider Demographics
NPI:1578843678
Name:SHUSTEF, ELINA MIKAELLA (DO)
Entity Type:Individual
Prefix:DR
First Name:ELINA
Middle Name:MIKAELLA
Last Name:SHUSTEF
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ELINA
Other - Middle Name:
Other - Last Name:TERUSHKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:10790 RANCHO BERNARDO RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-5705
Mailing Address - Country:US
Mailing Address - Phone:858-554-8605
Mailing Address - Fax:858-554-6748
Practice Address - Street 1:10666 N TORREY PINES RD
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1027
Practice Address - Country:US
Practice Address - Phone:858-554-8605
Practice Address - Fax:858-554-6748
Is Sole Proprietor?:No
Enumeration Date:2011-08-19
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A15510207ZP0102X, 207ND0900X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program