Provider Demographics
NPI:1598982100
Name:KAPULKIN, IRINA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MISS
First Name:IRINA
Middle Name:
Last Name:KAPULKIN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17777 VENTURA BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-3748
Mailing Address - Country:US
Mailing Address - Phone:818-990-6400
Mailing Address - Fax:
Practice Address - Street 1:17777 VENTURA BLVD STE 200
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-3748
Practice Address - Country:US
Practice Address - Phone:818-990-6400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44540183700000X
CA95016281363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No183700000XPharmacy Service ProvidersPharmacy Technician