Healthcare Provider Details

I. General information

NPI: 1093848269
Provider Name (Legal Business Name): IRENE WOJTKIEWICZ N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: IRENE M WOJEK N.P.

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 06/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3831 HUGHES AVE SUITE 506
CULVER CITY CA
90232-2751
US

IV. Provider business mailing address

17530 ORANGETREE DR
CARSON CA
90746-7470
US

V. Phone/Fax

Practice location:
  • Phone: 310-280-9670
  • Fax: 310-280-9675
Mailing address:
  • Phone: 310-635-0262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number552922
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number23040
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: