Provider Demographics
NPI:1275329021
Name:MASTOV, ELANA LEAH
Entity type:Individual
Prefix:MRS
First Name:ELANA
Middle Name:LEAH
Last Name:MASTOV
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 W MURIEL DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-6524
Mailing Address - Country:US
Mailing Address - Phone:602-326-1180
Mailing Address - Fax:
Practice Address - Street 1:249 W GROVERS AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85023-6515
Practice Address - Country:US
Practice Address - Phone:602-326-1180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-17
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health