Provider Demographics
NPI:1154184075
Name:SVERDLOVA, YELENA (EDD, RADT)
Entity type:Individual
Prefix:DR
First Name:YELENA
Middle Name:
Last Name:SVERDLOVA
Suffix:
Gender:F
Credentials:EDD, RADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1027
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-1027
Mailing Address - Country:US
Mailing Address - Phone:951-557-3777
Mailing Address - Fax:
Practice Address - Street 1:1718 CASEROS DR
Practice Address - Street 2:
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92582-3304
Practice Address - Country:US
Practice Address - Phone:951-557-3777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
No276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit