Provider Demographics
NPI:1740097559
Name:NICULAI, LEONTIN
Entity type:Individual
Prefix:
First Name:LEONTIN
Middle Name:
Last Name:NICULAI
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 1:859 SHETLAND CT
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:CA
Mailing Address - Zip Code:95648-2909
Mailing Address - Country:US
Mailing Address - Phone:916-755-9463
Mailing Address - Fax:916-909-3303
Practice Address - Street 1:859 SHETLAND CT
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:CA
Practice Address - Zip Code:95648-2909
Practice Address - Country:US
Practice Address - Phone:916-755-9463
Practice Address - Fax:916-909-3303
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA315002980310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility