Basic Information
| Provider Information | |||||||||
| NPI: | 1467021071 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VINNIKOVA | ||||||||
| FirstName: | IRINA | ||||||||
| MiddleName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1325 COTTONWOOD ST | ||||||||
| Address2: | |||||||||
| City: | WOODLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956955131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5306623961 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1325 COTTONWOOD ST | ||||||||
| Address2: | |||||||||
| City: | WOODLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956955131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5306623961 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2021 | ||||||||
| LastUpdateDate: | 06/18/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WM0705X | RN95169723 | CA | Y | Nursing Service Providers | Registered Nurse | Medical-Surgical |
ID Information
| ID | Type | State | Issuer | Description | 257051 | 01 | CA | DIGNITY HEALTH/COMMON SPIRIT HEALTH ORGANIZATION | OTHER |