Active NPI
Eugene James Nowak, D.O.
- Dermatology Physician
- Chula Vista, CA
National Provider Identifier
1619055878
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- 20A7103
- Practice address
- 2440 Fenton Street
Suite 101
Chula Vista, CA 91914-3516 - Phone
- (619) 420-1840
- Fax
- (619) 420-9630
- NPI assigned
- Nov 2, 2006
- Last updated
- Dec 2, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | 20A7103 | CA | Primary |
Addresses
Primary practice location
2440 Fenton Street
Suite 101
Chula Vista, CA 91914-3516
Mailing address
2440 Fenton St
Suite 101
Chula Vista, CA 91914-3516
Phone (619) 420-1840
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00AX71031 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Apr 22, 2014 through Apr 22, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20A7103 | CA | MD | Dermatology Physician |
| 7103 | CA | MD | Speech-Language Assistant |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Dermatopathology Physician
- Chula Vista, CA
- NPI 1750411427
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162425600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1259712000000",
"number": "1619055878",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2440 FENTON ST",
"address_2": "SUITE 101",
"city": "CHULA VISTA",
"state": "CA",
"postal_code": "919143516",
"telephone_number": "619-420-1840",
"fax_number": "619-420-9630"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2440 FENTON STREET",
"address_2": "SUITE 101",
"city": "CHULA VISTA",
"state": "CA",
"postal_code": "919143516",
"telephone_number": "619-420-1840",
"fax_number": "619-420-9630"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NOWAK",
"first_name": "EUGENE",
"middle_name": "JAMES",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-02",
"last_updated": "2009-12-02",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "CA",
"license": "20A7103",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00AX71031",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Chula Vista, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.