Supiyati, Ni Ketut

Supiyati, Ni Ketut is an sole proprietor health care provider with primary practice located at 2638 E Florence Ave , Huntington Park CA 90255-4708. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, which is considered as her primary health care specialty. Supiyati, Ni Ketut can be contacted via phone (323) 581-4665.

Contact Information

Primary practice address
2638 E Florence Ave Huntington Park CA 90255-4708
Phone: (323) 581-4665
Fax: (323) 581-0551
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X NP95001498 California

Profile Details

NPI number 1023497443
LBN Legal business name Supiyati, Ni Ketut
Credentials
Entity Individual
Sole proprietor 1 Yes
Enumeration date May 19th, 2015
Last updated May 19th, 2015 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1023497443 NPPES
California MEDICAID 95001498

Popular Providers