Basic Information
| Provider Information | |||||||||
| NPI: | 1124740816 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SINITSYNA | ||||||||
| FirstName: | ELENA | ||||||||
| MiddleName: | MIHAILOVNA | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3111 CAMINO DEL RIO N STE 625 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921085718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6197385566 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3111 CAMINO DEL RIO N STE 625 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921085718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6197385566 | ||||||||
| FaxNumber: | 6195660202 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2022 | ||||||||
| LastUpdateDate: | 09/19/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | NP95021351 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.