Provider Demographics
NPI:1750878674
Name:BLAGA, NICOLETA EUGENIA
Entity type:Individual
Prefix:
First Name:NICOLETA
Middle Name:EUGENIA
Last Name:BLAGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14681 WILSON ST
Mailing Address - Street 2:
Mailing Address - City:MIDWAY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92655-1069
Mailing Address - Country:US
Mailing Address - Phone:714-901-0705
Mailing Address - Fax:
Practice Address - Street 1:14681 WILSON ST
Practice Address - Street 2:
Practice Address - City:MIDWAY CITY
Practice Address - State:CA
Practice Address - Zip Code:92655-1069
Practice Address - Country:US
Practice Address - Phone:714-901-0705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-16
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator