Provider Demographics
NPI:1568695120
Name:NIKOLIC, JULIANNA KATA (BS, LSN)
Entity Type:Individual
Prefix:
First Name:JULIANNA
Middle Name:KATA
Last Name:NIKOLIC
Suffix:
Gender:F
Credentials:BS, LSN
Other - Prefix:
Other - First Name:JULIANNA
Other - Middle Name:KATA
Other - Last Name:FIRTEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS, LSN
Mailing Address - Street 1:PO BOX 5005
Mailing Address - Street 2:#132
Mailing Address - City:RANCHO SANTA FE
Mailing Address - State:CA
Mailing Address - Zip Code:92067-5005
Mailing Address - Country:US
Mailing Address - Phone:760-672-5810
Mailing Address - Fax:760-994-1248
Practice Address - Street 1:10225 AUSTIN DR
Practice Address - Street 2:STE 105
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91978-1500
Practice Address - Country:US
Practice Address - Phone:619-670-8028
Practice Address - Fax:619-670-9675
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-31
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA071017009133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist