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General NPI Number Information
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NPI Number | 1750470134
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Entity Type | Organization
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Legal Business Name | LA CLINIC OF MEDICINE GENETICS AND PREVENTIVE CARE
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 369 N FAIRFAX AVE STE 2
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City | LOS ANGELES
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State | CA
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Zip | 90036-2175
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Country | US
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Telephone | 323-655-2799
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Fax | 323-655-0556
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Provider Business Mailing Address
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Address Line | 647 N HARPER AVE
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City | LOS ANGELES
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State | CA
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Zip | 90048-2224
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Country | US
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Telephone | 323-655-2799
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Fax | 323-655-0556
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Authorized Official
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Title or Position | OWNER
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Name | YELENA SILVANSKAYA
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Credential |
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Telephone | 323-655-2799
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | A70174
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License Number State | CA
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