Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 35031 | CA |
NPI | 1639754013 |
---|---|
Provider Name | Dr. Nicole Kielkowicz |
First Address | San Clemente, CA 92673-2809 |
Second Address | San Clemente, CA 92673-2809 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2021 |
Last Update Date | 16/03/2021 |