Provider Demographics
NPI:1306288337
Name:MIKOLYSKI, TROY JEREMY
Entity type:Individual
Prefix:MR
First Name:TROY
Middle Name:JEREMY
Last Name:MIKOLYSKI
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 1:1859 GALT ST
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-3415
Mailing Address - Country:US
Mailing Address - Phone:805-404-6553
Mailing Address - Fax:
Practice Address - Street 1:1227 E LOS ANGELES AVE
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-2871
Practice Address - Country:US
Practice Address - Phone:805-582-4080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-18
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program