MEDICARE: TEHILA TANYA ABREKOV

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	95006397	CA

General Provider Information

NPI Number	:	1295248110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TEHILA TANYA ABREKOV

Provider Business Mailing Address
First Line	:	1539 S SHENANDOAH ST APT 303
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90035-4479
Country	:	US
Telephone Number	:	818-203-4712
Fax Number	:

Provider Business Practice Location Address
First Line	:	1539 S SHENANDOAH ST APT 303
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90035-4479
Country	:	US
Telephone Number	:	818-203-4712
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/14/2017
Last Update Date	:	11/14/2017

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Directions to “ TEHILA TANYA ABREKOV ” Practice Location

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