Provider Demographics
NPI:1427419316
Name:KWIATKOWSKA, BEATA JOANNA (MD)
Entity Type:Individual
Prefix:
First Name:BEATA
Middle Name:JOANNA
Last Name:KWIATKOWSKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BEATA
Other - Middle Name:JOANNA
Other - Last Name:KWIATKOWSKA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2937 CHANNEL BAY DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-7288
Mailing Address - Country:US
Mailing Address - Phone:702-306-5140
Mailing Address - Fax:
Practice Address - Street 1:2937 CHANNEL BAY DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-7288
Practice Address - Country:US
Practice Address - Phone:702-306-5140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-18
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9542207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine