Provider Demographics
NPI:1093155350
Name:NUKALA, ASWIN (MD)
Entity Type:Individual
Prefix:DR
First Name:ASWIN
Middle Name:
Last Name:NUKALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 OUTLET CENTER DR
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-0677
Mailing Address - Country:US
Mailing Address - Phone:805-485-2400
Mailing Address - Fax:805-485-3025
Practice Address - Street 1:1910 OUTLET CENTER DR
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-0677
Practice Address - Country:US
Practice Address - Phone:805-485-2400
Practice Address - Fax:805-485-3025
Is Sole Proprietor?:No
Enumeration Date:2013-07-01
Last Update Date:2021-05-20
Deactivation Date:2018-11-09
Deactivation Code:
Reactivation Date:2018-12-06
Provider Licenses
StateLicense IDTaxonomies
IL036145826207R00000X
CAA141621207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine