Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 95012495 | CA |
NPI | 1013566520 |
---|---|
Provider Name | Yevgeniy Glukhovsky |
First Address | Tarzana, CA 91356-2806 |
Second Address | Tarzana, CA 91356-2806 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2019 |
Last Update Date | 06/09/2019 |