Provider Demographics
NPI:1841058757
Name:MALYGIN, ILONA V
Entity type:Individual
Prefix:
First Name:ILONA
Middle Name:V
Last Name:MALYGIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ILONA
Other - Middle Name:
Other - Last Name:MALYGIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LUNA SKIN SOLUTION
Mailing Address - Street 1:13439 MOORPARK ST # 39E
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-3841
Mailing Address - Country:US
Mailing Address - Phone:818-300-7930
Mailing Address - Fax:
Practice Address - Street 1:16550 VENTURA BLVD STE 204
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-4563
Practice Address - Country:US
Practice Address - Phone:818-300-7930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPR0282219246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other