Provider Demographics
NPI:1215075049
Name:PINDERSKI, SOUKAHN NONTHAVET
Entity type:Individual
Prefix:MS
First Name:SOUKAHN
Middle Name:NONTHAVET
Last Name:PINDERSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SOUKAHN
Other - Middle Name:NONTHAVET
Other - Last Name:PINDERSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:8405 BEVERLY BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-3401
Mailing Address - Country:US
Mailing Address - Phone:323-330-1619
Mailing Address - Fax:
Practice Address - Street 1:8405 BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-3401
Practice Address - Country:US
Practice Address - Phone:323-330-1619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN428807 NP10902372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider