Healthcare Provider Details

I. General information

NPI: 1922390996
Provider Name (Legal Business Name): PALOMA WOMEN'S CLINIC AND MEDICAL CENTER, NURSING P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2011
Last Update Date: 05/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2670 E GAGE AVE STE 4
HUNTINGTON PARK CA
90255-4176
US

IV. Provider business mailing address

2670 E GAGE AVE STE 4
HUNTINGTON PARK CA
90255-4176
US

V. Phone/Fax

Practice location:
  • Phone: 323-588-2005
  • Fax: 323-588-2004
Mailing address:
  • Phone: 323-588-2005
  • Fax: 323-588-2004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number681341
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number681341
License Number StateCA

VIII. Authorized Official

Name: MRS. LARISA ZABOKRITSKAYA
Title or Position: PRESIDENT
Credential: FNP
Phone: 310-940-2001