Provider Demographics
NPI:1386070837
Name:GORBUNOVA, ELENA E (MS, LICAC, PA-C)
Entity type:Individual
Prefix:MISS
First Name:ELENA
Middle Name:E
Last Name:GORBUNOVA
Suffix:
Gender:F
Credentials:MS, LICAC, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2721 NE 53RD ST
Mailing Address - Street 2:
Mailing Address - City:LIGHTHOUSE POINT
Mailing Address - State:FL
Mailing Address - Zip Code:33064-7847
Mailing Address - Country:US
Mailing Address - Phone:207-416-7091
Mailing Address - Fax:561-245-7217
Practice Address - Street 1:2061 NW BOCA RATON BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-7411
Practice Address - Country:US
Practice Address - Phone:561-245-7217
Practice Address - Fax:561-245-7217
Is Sole Proprietor?:No
Enumeration Date:2013-09-16
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3265171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist