Provider Demographics
NPI:1275857815
Name:WULKOWICZ, TALIA M
Entity Type:Individual
Prefix:MRS
First Name:TALIA
Middle Name:M
Last Name:WULKOWICZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 F ST
Mailing Address - Street 2:300
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-2645
Mailing Address - Country:US
Mailing Address - Phone:619-585-4080
Mailing Address - Fax:619-427-4572
Practice Address - Street 1:344 F ST
Practice Address - Street 2:300
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-2645
Practice Address - Country:US
Practice Address - Phone:619-585-4080
Practice Address - Fax:619-427-4572
Is Sole Proprietor?:No
Enumeration Date:2010-03-25
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA328792251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic