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General NPI Number Information
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NPI Number | 1881377125
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Entity Type | Individual
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Provider Name | ELENA SUKHORUKOV NMD
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Gender | Female
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Dates
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Enumeration Date | 08/14/2023
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Last Update Date | 08/20/2023
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Provider Practice Location Address
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Address Line | 591 E PLAZA CIR UNIT 1888
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City | LITCHFIELD PARK
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State | AZ
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Zip | 85340-7675
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Country | US
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Telephone | 619-894-9804
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Fax |
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Provider Business Mailing Address
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Address Line | 591 E PLAZA CIR UNIT 1888
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City | LITCHFIELD PARK
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State | AZ
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Zip | 85340-7675
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Country | US
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Telephone | 619-894-9804
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Fax |
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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 | 175F00000X
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Taxonomy Name | Naturopath
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License Number | 23-1789
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License Number State | AZ
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