Provider Demographics
NPI:1578636114
Name:WUKADINOVICH, KARIN (LPT)
Entity Type:Individual
Prefix:MS
First Name:KARIN
Middle Name:
Last Name:WUKADINOVICH
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73450 COUNTRY CLUB
Mailing Address - Street 2:# 268
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260
Mailing Address - Country:US
Mailing Address - Phone:760-776-8380
Mailing Address - Fax:
Practice Address - Street 1:68615 PEREZ RD
Practice Address - Street 2:SUITE # 6A
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234
Practice Address - Country:US
Practice Address - Phone:760-770-2222
Practice Address - Fax:760-770-2249
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT23280167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician