Individual
ANNA ILYINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LE
Contact information
Practice address
11645 WILSHIRE BLVD STE 701, LOS ANGELES, CA 90025-6810
(310) 720-6646
Mailing address
7158 HAWTHORN AVE APT 301, LOS ANGELES, CA 90046-3269
(323) 640-0497
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
L0031
CA
Other
Enumeration date
07/15/2024
Last updated
07/15/2024
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