Provider Demographics
NPI:1427592476
Name:TUMASYAN, YELENA (PA)
Entity type:Individual
Prefix:
First Name:YELENA
Middle Name:
Last Name:TUMASYAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4252 FAIR AVE UNIT 11
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91602-3069
Mailing Address - Country:US
Mailing Address - Phone:516-603-1047
Mailing Address - Fax:
Practice Address - Street 1:2595 E WASHINGTON BLVD STE 106
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-1409
Practice Address - Country:US
Practice Address - Phone:310-878-0964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-09
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53709363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant