Healthcare Provider Details

I. General information

NPI: 1003044785
Provider Name (Legal Business Name): MICHAEL JOSEPH PLOTKOWSKI PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2009
Last Update Date: 09/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24565 TOWN CENTER DR APT 8206
VALENCIA CA
91355-1371
US

IV. Provider business mailing address

24565 TOWN CENTER DR APT 8206
VALENCIA CA
91355-0817
US

V. Phone/Fax

Practice location:
  • Phone: 813-784-8456
  • Fax:
Mailing address:
  • Phone: 813-784-8456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1087705
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number51684
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: