Provider Demographics
NPI:1639615776
Name:ZLOCHEVSKY, ELENA (NP)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:ZLOCHEVSKY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 W FOOTHILL PKWY STE 105-189
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-8545
Mailing Address - Country:US
Mailing Address - Phone:310-692-1616
Mailing Address - Fax:866-927-0455
Practice Address - Street 1:160 W FOOTHILL PKWY STE 105-189
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-8545
Practice Address - Country:US
Practice Address - Phone:310-692-1616
Practice Address - Fax:866-927-0455
Is Sole Proprietor?:No
Enumeration Date:2017-01-12
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95005705363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95005705OtherAANP