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General NPI Number Information
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NPI Number | 1982912317
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Entity Type | Organization
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Legal Business Name | MEDICAL CREATIONS LLC
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Dates
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Enumeration Date | 09/20/2010
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Last Update Date | 09/20/2010
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Provider Practice Location Address
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Address Line | 2424 WILLIAMS BLVD SUITE J
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City | KENNER
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State | LA
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Zip | 70062-5763
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Country | US
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Telephone | 646-644-7303
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Fax |
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Provider Business Mailing Address
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Address Line | 2424 WILLIAMS BLVD SUITE J
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City | KENNER
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State | LA
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Zip | 70062-5763
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Country | US
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Telephone | 646-644-7303
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. YELENA IVANOVA
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Credential | MD
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Telephone | 646-644-7303
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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 | MD203355
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License Number State | LA
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