Healthcare Provider Details

I. General information

NPI: 1962306993
Provider Name (Legal Business Name): YELIZAVETA BOSTAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 STOCKTON BLVD
SACRAMENTO CA
95817-1337
US

IV. Provider business mailing address

8176 WAIKIKI DR
FAIR OAKS CA
95628-3747
US

V. Phone/Fax

Practice location:
  • Phone: 916-875-1000
  • Fax:
Mailing address:
  • Phone: 916-996-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: