Provider Demographics
NPI:1639506322
Name:KRYUKOVA, ALLA (CRNA)
Entity Type:Individual
Prefix:MS
First Name:ALLA
Middle Name:
Last Name:KRYUKOVA
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:ALLA
Other - Middle Name:
Other - Last Name:MILSHTEYN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:17500 SHERMAN WAY UNIT 101
Mailing Address - Street 2:
Mailing Address - City:LAKE BALBOA
Mailing Address - State:CA
Mailing Address - Zip Code:91406-3556
Mailing Address - Country:US
Mailing Address - Phone:818-585-0326
Mailing Address - Fax:
Practice Address - Street 1:1200 N STATE ST
Practice Address - Street 2:LA USC COUNTY MEDICAL CENTER
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033
Practice Address - Country:US
Practice Address - Phone:323-226-2622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-26
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA564226163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse