Provider Demographics
NPI:1871735647
Name:BOSTANJIAN, ELLA YEPRAKSIA (MD)
Entity type:Individual
Prefix:
First Name:ELLA
Middle Name:YEPRAKSIA
Last Name:BOSTANJIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 5TH AVE S
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-3452
Mailing Address - Country:US
Mailing Address - Phone:425-697-2100
Mailing Address - Fax:425-697-5556
Practice Address - Street 1:617 5TH AVE S
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-3452
Practice Address - Country:US
Practice Address - Phone:425-697-2100
Practice Address - Fax:425-697-5556
Is Sole Proprietor?:No
Enumeration Date:2009-03-25
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60039274208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice