Provider Demographics
NPI:1669104683
Name:SARKISYAN, ELEN TINA (DO)
Entity type:Individual
Prefix:
First Name:ELEN
Middle Name:TINA
Last Name:SARKISYAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 NATOIRE CT
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-1014
Mailing Address - Country:US
Mailing Address - Phone:818-371-6667
Mailing Address - Fax:
Practice Address - Street 1:326 NATOIRE CT
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89012-1014
Practice Address - Country:US
Practice Address - Phone:818-371-6667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-28
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SL1986390200000X
NVDO3955207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program