Provider Demographics
NPI:1205148871
Name:LINETSKIY, ELAINA (MD)
Entity type:Individual
Prefix:DR
First Name:ELAINA
Middle Name:
Last Name:LINETSKIY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELAINA
Other - Middle Name:
Other - Last Name:KEATS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2210 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE 00
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404
Mailing Address - Country:US
Mailing Address - Phone:310-829-3525
Mailing Address - Fax:310-829-7437
Practice Address - Street 1:2210 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 00
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404
Practice Address - Country:US
Practice Address - Phone:310-829-3525
Practice Address - Fax:310-829-7437
Is Sole Proprietor?:No
Enumeration Date:2010-07-11
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA127004208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program