Healthcare Provider Details

I. General information

NPI: 1467157438
Provider Name (Legal Business Name): NIKOLAS ALEXANDER UJUETA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2023
Last Update Date: 03/31/2023
Certification Date: 03/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N STATE ST
LOS ANGELES CA
90089-1001
US

IV. Provider business mailing address

898 SW 173RD AVE
PEMBROKE PINES FL
33029-4219
US

V. Phone/Fax

Practice location:
  • Phone: 323-409-7053
  • Fax:
Mailing address:
  • Phone: 754-244-7880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: