Provider Demographics
NPI:1407406572
Name:PENA KATKOVA, JULIA
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:PENA KATKOVA
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 1:3478 PARADISE RD # APPT129
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-2701
Mailing Address - Country:US
Mailing Address - Phone:702-845-5923
Mailing Address - Fax:
Practice Address - Street 1:3478 PARADISE RD # APPT129
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-2701
Practice Address - Country:US
Practice Address - Phone:702-845-5923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion