Organization
CONSTANTINE ELISSEEV
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CONSTANTINE ELISSEEV (MANAGER)
(310) 899-6818
Entity
Organization
Contact information
Practice address
500 CALIFORNIA AVE, SANTA MONICA, CA 90403-3943
(310) 899-6818
Mailing address
500 CALIFORNIA AVE, SANTA MONICA, CA 90403-3943
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
6685
CA
Other
Enumeration date
03/19/2010
Last updated
03/20/2010
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