Healthcare Provider Details

I. General information

NPI: 1174195085
Provider Name (Legal Business Name): AJK PERIOPERATIVE NURSING SERVICES INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2021
Last Update Date: 07/12/2021
Certification Date: 07/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30200 AGOURA RD STE 195
AGOURA HILLS CA
91301-5432
US

IV. Provider business mailing address

21201 KITTRIDGE ST APT 9406
WOODLAND HILLS CA
91303-5044
US

V. Phone/Fax

Practice location:
  • Phone: 805-497-3622
  • Fax:
Mailing address:
  • Phone: 412-508-0806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number
License Number State

VIII. Authorized Official

Name: AMELIA KOLENC
Title or Position: NURSE PRACTITIONER
Credential:
Phone: 412-508-0806