Healthcare Provider Details

I. General information

NPI: 1124740816
Provider Name (Legal Business Name): ELENA MIHAILOVNA SINITSYNA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2022
Last Update Date: 09/19/2022
Certification Date: 09/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3111 CAMINO DEL RIO N STE 625
SAN DIEGO CA
92108-5718
US

IV. Provider business mailing address

3111 CAMINO DEL RIO N STE 625
SAN DIEGO CA
92108-5718
US

V. Phone/Fax

Practice location:
  • Phone: 619-738-5566
  • Fax: 619-566-0202
Mailing address:
  • Phone: 619-738-5566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP95021351
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: