Basic Information
| Provider Information | |||||||||
| NPI: | 1750044582 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NIKITYUK | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | OLEG | ||||||||
| NamePrefix: | |||||||||
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| Credential: | SUDRC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2100 CAPITOL AVE | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958165721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164424985 | ||||||||
| FaxNumber: | 9164421029 | ||||||||
| Practice Location | |||||||||
| Address1: | 2100 CAPITOL AVE | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958165721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164424985 | ||||||||
| FaxNumber: | 9164421029 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2021 | ||||||||
| LastUpdateDate: | 11/01/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 12415 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.