Healthcare Provider Details

I. General information

NPI: 1891424644
Provider Name (Legal Business Name): PTASHINSKY MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2022
Last Update Date: 03/06/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54910 N CIRCLE DRIVE
IDYLLWILD CA
92549
US

IV. Provider business mailing address

PO BOX 786
IDYLLWILD CA
92549-0786
US

V. Phone/Fax

Practice location:
  • Phone: 917-225-6302
  • Fax:
Mailing address:
  • Phone: 917-225-6302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NATALYA PTASHINSKY
Title or Position: AUTHORIZED OFFICIAL
Credential: A/GNP
Phone: 917-225-6302