Provider Demographics
NPI:1740225473
Name:USMANOVA, YELENA VICTOROVNA (MD)
Entity Type:Individual
Prefix:DR
First Name:YELENA
Middle Name:VICTOROVNA
Last Name:USMANOVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 L ST # 500
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5616
Mailing Address - Country:US
Mailing Address - Phone:916-454-6850
Mailing Address - Fax:916-454-6852
Practice Address - Street 1:2800 L ST # 500
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5616
Practice Address - Country:US
Practice Address - Phone:916-454-6850
Practice Address - Fax:916-454-6852
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC1709962084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34294200Medicaid
MN130024029OtherRAILROAD MEDICARE
MN140925C029OtherUCARE
MNHP33315OtherHEALTHPARTNERS
MN1336364OtherAMERICA'S PPO
MN0500174OtherMEDICA
MN69B63USOtherBCBS OF MN
MN026606000Medicaid
MN1028307OtherPREFERRED ONE
MNH45570Medicare UPIN
WI34294200Medicaid