Basic Information
| Provider Information | |||||||||
| NPI: | 1093155350 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NUKALA | ||||||||
| FirstName: | ASWIN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1910 OUTLET CENTER DR | ||||||||
| Address2: | |||||||||
| City: | OXNARD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930360677 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8054852400 | ||||||||
| FaxNumber: | 8054853025 | ||||||||
| Practice Location | |||||||||
| Address1: | 1910 OUTLET CENTER DR | ||||||||
| Address2: | |||||||||
| City: | OXNARD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930360677 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8054852400 | ||||||||
| FaxNumber: | 8054853025 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2013 | ||||||||
| LastUpdateDate: | 05/20/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 11/09/2018 | ||||||||
| NPIReactivationDate: | 12/06/2018 | ||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 036145826 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0200X | A141621 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RP1001X | A141621 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
No ID Information.