Provider Demographics
NPI:1124740816
Name:SINITSYNA, ELENA MIHAILOVNA (NP)
Entity type:Individual
Prefix:
First Name:ELENA
Middle Name:MIHAILOVNA
Last Name:SINITSYNA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3111 CAMINO DEL RIO N STE 625
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-5718
Mailing Address - Country:US
Mailing Address - Phone:619-738-5566
Mailing Address - Fax:
Practice Address - Street 1:3111 CAMINO DEL RIO N STE 625
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-5718
Practice Address - Country:US
Practice Address - Phone:619-738-5566
Practice Address - Fax:619-566-0202
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95021351363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner