Provider Demographics
NPI:1720768898
Name:KOSTYUKEVICH, OKSANA LELYUKH (PA-C)
Entity Type:Individual
Prefix:
First Name:OKSANA
Middle Name:LELYUKH
Last Name:KOSTYUKEVICH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11938 PARAMOUNT BLVD
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90242-2306
Mailing Address - Country:US
Mailing Address - Phone:562-923-6060
Mailing Address - Fax:562-923-6601
Practice Address - Street 1:11938 PARAMOUNT BLVD
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242-2306
Practice Address - Country:US
Practice Address - Phone:562-923-6060
Practice Address - Fax:562-923-6601
Is Sole Proprietor?:No
Enumeration Date:2023-07-24
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PA63203363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant