Provider Demographics
NPI:1922390996
Name:PALOMA WOMEN'S CLINIC AND MEDICAL CENTER, NURSING P.C
Entity Type:Organization
Organization Name:PALOMA WOMEN'S CLINIC AND MEDICAL CENTER, NURSING P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LARISA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZABOKRITSKAYA
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:310-940-2001
Mailing Address - Street 1:2670 E GAGE AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-4176
Mailing Address - Country:US
Mailing Address - Phone:323-588-2005
Mailing Address - Fax:323-588-2004
Practice Address - Street 1:2670 E GAGE AVE STE 4
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-4176
Practice Address - Country:US
Practice Address - Phone:323-588-2005
Practice Address - Fax:323-588-2004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-10
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA681341363LF0000X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & GynecologyGroup - Multi-Specialty