Provider Demographics
NPI:1609585207
Name:SOLODUKHA, INNA
Entity Type:Individual
Prefix:
First Name:INNA
Middle Name:
Last Name:SOLODUKHA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9561 VIA RICARDO
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91504-1218
Mailing Address - Country:US
Mailing Address - Phone:818-450-4276
Mailing Address - Fax:
Practice Address - Street 1:1500 E GAGE AVE APT 6
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90001-1724
Practice Address - Country:US
Practice Address - Phone:818-450-4276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-22
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95034021163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse