Provider Demographics
NPI:1184664237
Name:NUKAL, SAVITHA (MD)
Entity Type:Individual
Prefix:DR
First Name:SAVITHA
Middle Name:
Last Name:NUKAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:895 AEROVISTA PL STE 103
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-8725
Mailing Address - Country:US
Mailing Address - Phone:805-541-3200
Mailing Address - Fax:805-541-3700
Practice Address - Street 1:895 AEROVISTA PL STE 103
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-8725
Practice Address - Country:US
Practice Address - Phone:805-541-3200
Practice Address - Fax:805-541-3700
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME110541207R00000X
CAA72912207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB246593OtherMEDICARE ID
183948200OtherUSDOL
CA00A729120OtherBLUE SHIELD OF CALIFORNIA
CA00A729120Medicaid
183948200OtherUSDOL
H24045Medicare UPIN
CA00A729120Medicaid