Provider Demographics
NPI:1265903520
Name:ALATIW, WYNDELL D
Entity type:Individual
Prefix:
First Name:WYNDELL
Middle Name:D
Last Name:ALATIW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1566 WISHING STAR DR
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91915-1823
Mailing Address - Country:US
Mailing Address - Phone:619-888-0927
Mailing Address - Fax:
Practice Address - Street 1:1566 WISHING STAR DR
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91915-1823
Practice Address - Country:US
Practice Address - Phone:619-888-0927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA575116163WN0002X, 163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care