Pauline Ann Derdzinska, LVN

Primary specialty

Licensed Vocational NurseTaxonomy code 164X00000X

License

276768 Issued in CA

Practice address

1260 Morena Blvd Ste 100
San Diego, CA 92110-3850

Phone

(619) 275-0822

NPI assigned

Dec 2, 2018

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Pauline Ann Kuczera Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1543708800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1543708800000",
    "number": "1851861983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1260 MORENA BLVD STE 100",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921103850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1260 MORENA BLVD STE 100",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921103850",
            "telephone_number": "619-275-0822"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERDZINSKA",
        "first_name": "PAULINE",
        "middle_name": "ANN",
        "credential": "LVN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-12-02",
        "last_updated": "2018-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "164X00000X",
            "taxonomy_group": "",
            "desc": "Licensed Vocational Nurse",
            "state": "CA",
            "license": "276768",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PAULINE",
            "last_name": "KUCZERA",
            "middle_name": "ANN",
            "credential": "LVN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kiara Der
• Maryam Derakhshani
• Ray Derakshan, D.M.D
• Bayron Deraz Rivera
• Emily Jacobs Derby
• Jessica Ann Deree, M.D.
• Timothy James Derego, FNP-C
• Katherine Rene Derflinger
• Gina Derham
• David A Deriemer, MD

• Licensed Vocational Nurse in San Diego, CA
• Providers in San Diego, CA by specialty
• Licensed Vocational Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.