Provider Demographics
NPI:1487946729
Name:KIZLINSKI, AILEEN (NP)
Entity type:Individual
Prefix:MR
First Name:AILEEN
Middle Name:
Last Name:KIZLINSKI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1922 GRAHAM AVE # A
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-1921
Mailing Address - Country:US
Mailing Address - Phone:562-432-9575
Mailing Address - Fax:562-432-9590
Practice Address - Street 1:2125 SANTA FE AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90810-3547
Practice Address - Country:US
Practice Address - Phone:562-432-9575
Practice Address - Fax:562-432-9590
Is Sole Proprietor?:No
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA565209363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily