Provider Demographics
NPI:1922268408
Name:NUTKIEWICZ, ALLAN ISAAC (MD)
Entity Type:Individual
Prefix:
First Name:ALLAN
Middle Name:ISAAC
Last Name:NUTKIEWICZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17915 VENTURA BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-4810
Mailing Address - Country:US
Mailing Address - Phone:818-938-9175
Mailing Address - Fax:818-938-9173
Practice Address - Street 1:17915 VENTURA BLVD STE 220
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-4810
Practice Address - Country:US
Practice Address - Phone:818-938-9175
Practice Address - Fax:818-938-9173
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-10
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32050207T00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No251E00000XAgenciesHome Health