Provider Demographics
NPI:1770164246
Name:KULYAMINA, IRINA (ATC)
Entity type:Individual
Prefix:
First Name:IRINA
Middle Name:
Last Name:KULYAMINA
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3395 CORDILLERA CT
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92010
Mailing Address - Country:US
Mailing Address - Phone:619-384-3830
Mailing Address - Fax:
Practice Address - Street 1:1337 LOWER CAMPUS RD
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96822-2352
Practice Address - Country:US
Practice Address - Phone:619-384-3830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-16
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
20000522772255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer