Provider Demographics
NPI:1285472217
Name:ILYINA, ANNA (LE)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:ILYINA
Suffix:
Gender:F
Credentials:LE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7158 HAWTHORN AVE APT 301
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046-3269
Mailing Address - Country:US
Mailing Address - Phone:323-640-0497
Mailing Address - Fax:
Practice Address - Street 1:11645 WILSHIRE BLVD STE 701
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-6810
Practice Address - Country:US
Practice Address - Phone:310-720-6646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL0031174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist