Provider Demographics
NPI:1376634774
Name:SHULGINA, IRINA (PAC)
Entity Type:Individual
Prefix:
First Name:IRINA
Middle Name:
Last Name:SHULGINA
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5810 JAMESON CT
Mailing Address - Street 2:STE 1
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608
Mailing Address - Country:US
Mailing Address - Phone:916-979-0621
Mailing Address - Fax:916-979-1110
Practice Address - Street 1:5810 JAMESON CT
Practice Address - Street 2:STE 1
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608
Practice Address - Country:US
Practice Address - Phone:916-979-0621
Practice Address - Fax:916-979-1110
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16372208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PA163720Medicaid
CA0PA163720Medicare ID - Type Unspecified
CA0PA163720Medicaid