Healthcare Provider Details

I. General information

NPI: 1558184747
Provider Name (Legal Business Name): NUKALA MED INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2024
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11716 ABBEY LN
PORTER RANCH CA
91326-2469
US

IV. Provider business mailing address

11716 ABBEY LN
PORTER RANCH CA
91326-2469
US

V. Phone/Fax

Practice location:
  • Phone: 314-422-1432
  • Fax:
Mailing address:
  • Phone: 314-422-1432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: PAULA O SPEARMAN
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 985-778-3357