Provider Demographics
NPI:1942248000
Name:SMUSHKOVICH, EMILIA (MD)
Entity Type:Individual
Prefix:DR
First Name:EMILIA
Middle Name:
Last Name:SMUSHKOVICH
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 1:11301 WILSHIRE BLVD # 10C1
Mailing Address - Street 2:BLDG 500,ROOM 1A010(PACC)
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90073-1003
Mailing Address - Country:US
Mailing Address - Phone:310-478-3711
Mailing Address - Fax:310-268-4433
Practice Address - Street 1:11301 WILSHIRE BLVD
Practice Address - Street 2:BLD 500(10C1)
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90073-1003
Practice Address - Country:US
Practice Address - Phone:310-478-3711
Practice Address - Fax:310-268-4433
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC50078207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine