Provider Demographics
NPI:1093848269
Name:WOJTKIEWICZ, IRENE (NP)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:WOJTKIEWICZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:IRENE
Other - Middle Name:M
Other - Last Name:WOJEK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:17530 ORANGETREE DR
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-7470
Mailing Address - Country:US
Mailing Address - Phone:310-635-0262
Mailing Address - Fax:
Practice Address - Street 1:3831 HUGHES AVE
Practice Address - Street 2:SUITE 506
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-2751
Practice Address - Country:US
Practice Address - Phone:310-280-9670
Practice Address - Fax:310-280-9675
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA552922163W00000X
CA23040363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA552922OtherRN LICENSE
CA23040OtherNP LICENSE