Healthcare Provider Details

I. General information

NPI: 1891229167
Provider Name (Legal Business Name): YELENA AYZENBERG PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2017
Last Update Date: 04/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3935 COCHRAN ST
SIMI VALLEY CA
93063-2364
US

IV. Provider business mailing address

3935 COCHRAN ST
SIMI VALLEY CA
93063-2364
US

V. Phone/Fax

Practice location:
  • Phone: 805-581-1800
  • Fax: 805-581-5315
Mailing address:
  • Phone: 805-581-1800
  • Fax: 805-581-5315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number73471
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: