Healthcare Provider Details

I. General information

NPI: 1730159922
Provider Name (Legal Business Name): YELENA S LAPIDUS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 02/18/2021
Certification Date: 02/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6685 BAY LAUREL PLACE
AVILA BEACH CA
93424
US

IV. Provider business mailing address

PO BOX 490
AVILA BEACH CA
93424-0490
US

V. Phone/Fax

Practice location:
  • Phone: 805-439-4825
  • Fax: 805-540-3072
Mailing address:
  • Phone: 805-540-3071
  • Fax: 805-540-3072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA88176
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License NumberA88176
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: