Provider Demographics
NPI:1154300457
Name:ZIOMEK, NICK B (PA)
Entity Type:Individual
Prefix:
First Name:NICK
Middle Name:B
Last Name:ZIOMEK
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:39000 BOB HOPE DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-3221
Mailing Address - Country:US
Mailing Address - Phone:760-834-3593
Mailing Address - Fax:760-564-0101
Practice Address - Street 1:45280 SEELEY DR
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-6834
Practice Address - Country:US
Practice Address - Phone:760-834-3593
Practice Address - Fax:760-564-0101
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2020-02-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA19012363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41989900Medicaid
WIQ22026Medicare UPIN
WI41989900Medicaid