Provider Demographics
NPI:1104291954
Name:BIGILINKA, EZAKAR
Entity type:Individual
Prefix:
First Name:EZAKAR
Middle Name:
Last Name:BIGILINKA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29588 CREST VIEW LN
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:CA
Mailing Address - Zip Code:92346-7712
Mailing Address - Country:US
Mailing Address - Phone:909-528-8162
Mailing Address - Fax:
Practice Address - Street 1:510 S VERMONT AVE FL 21
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-1992
Practice Address - Country:US
Practice Address - Phone:909-528-8162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-04
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA809561163WP0808X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health