Healthcare Provider Details

I. General information

NPI: 1487946729
Provider Name (Legal Business Name): AILEEN KIZLINSKI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2011
Last Update Date: 05/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2125 SANTA FE AVE
LONG BEACH CA
90810-3547
US

IV. Provider business mailing address

1922 GRAHAM AVE # A
REDONDO BEACH CA
90278-1921
US

V. Phone/Fax

Practice location:
  • Phone: 562-432-9575
  • Fax: 562-432-9590
Mailing address:
  • Phone: 562-432-9575
  • Fax: 562-432-9590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number565209
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: