1568695120 NPI number — JULIANNA KATA NIKOLIC B.S., LSN

Table of content: JULIANNA KATA NIKOLIC B.S., LSN (NPI 1568695120)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568695120 NPI number — JULIANNA KATA NIKOLIC B.S., LSN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NIKOLIC
Provider First Name:
JULIANNA
Provider Middle Name:
KATA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
B.S., LSN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FIRTEL
Provider Other First Name:
JULIANNA
Provider Other Middle Name:
KATA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
B.S., LSN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1568695120
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/31/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5005
Provider Second Line Business Mailing Address:
#132
Provider Business Mailing Address City Name:
RANCHO SANTA FE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92067-5005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-672-5810
Provider Business Mailing Address Fax Number:
760-994-1248

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10225 AUSTIN DR
Provider Second Line Business Practice Location Address:
STE 105
Provider Business Practice Location Address City Name:
SPRING VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91978-1500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-670-8028
Provider Business Practice Location Address Fax Number:
619-670-9675
Provider Enumeration Date:
08/31/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133N00000X , with the licence number:  071017009 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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