MEDICARE: MS. ELENA SOLTANOVSKAYA M.A

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	174400000X	Specialist	BTC#03019045	CA

General Provider Information

NPI Number	:	1831480672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELENA SOLTANOVSKAYA M.A

Provider Business Mailing Address
First Line	:	5995 MISSION GORGE RD
Second Line	:	B
City	:	SAN DIEGO
State	:	CA
Zip	:	92120-4028
Country	:	US
Telephone Number	:	619-322-8551
Fax Number	:

Provider Business Practice Location Address
First Line	:	5995 MISSION GORGE RD
Second Line	:	B
City	:	SAN DIEGO
State	:	CA
Zip	:	92120-4028
Country	:	US
Telephone Number	:	619-322-8551
Fax Number	:

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

Provider Enumeration Date	:	04/27/2011
Last Update Date	:	04/27/2011

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