Individual
MRS. ELENA SHOSTAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
14600 SHERMAN WAY STE 250, VAN NUYS, CA 91405-2284
(818) 212-2223
(818) 212-2224
Mailing address
6021 LINDLEY AVE UNIT 8, TARZANA, CA 91356-1726
(323) 788-8277
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
53310
CA
363AM0700X
Medical Physician Assistant
53310
CA
363AS0400X
Surgical Physician Assistant
53310
CA
Other
Enumeration date
08/18/2016
Last updated
08/29/2016
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