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General NPI Number Information
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NPI Number | 1821061680
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Entity Type | Individual
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Provider Name | YELENA M. POPOVA PAC
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Gender | Female
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Dates
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Enumeration Date | 02/10/2006
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Last Update Date | 06/18/2015
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Provider Practice Location Address
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Address Line | 3234 MARYSVILLE BLVD
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City | SACRAMENTO
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State | CA
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Zip | 95815-1411
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Country | US
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Telephone | 916-646-1200
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Fax | 877-860-2703
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Provider Business Mailing Address
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Address Line | 200 OCEANGATE SUITE 100
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City | LONG BEACH
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State | CA
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Zip | 90802-4317
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Country | US
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Telephone | 562-499-6191
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Fax | 877-860-2703
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | PA18255
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA18255
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License Number State | CA
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