Provider Demographics
NPI:1154390888
Name:SKURJA, MICHAEL NMN JR (PT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:NMN
Last Name:SKURJA
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12337 REATA CT
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-1251
Mailing Address - Country:US
Mailing Address - Phone:858-592-9504
Mailing Address - Fax:858-451-3838
Practice Address - Street 1:NAVAL HOSPTIAL, NEUROLOGY DEPARTMENT
Practice Address - Street 2:BOX 555191
Practice Address - City:CAMP PENDLETON
Practice Address - State:CA
Practice Address - Zip Code:92055
Practice Address - Country:US
Practice Address - Phone:760-725-1384
Practice Address - Fax:760-725-1411
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 005817174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist