Provider Demographics
NPI:1700316817
Name:PIRAKITIKULR, NATHAN (MD, PHD)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:PIRAKITIKULR
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 N HIGHWAY 101
Mailing Address - Street 2:
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-1132
Mailing Address - Country:US
Mailing Address - Phone:858-529-9973
Mailing Address - Fax:
Practice Address - Street 1:531 N HIGHWAY 101
Practice Address - Street 2:
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-1132
Practice Address - Country:US
Practice Address - Phone:858-529-9973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA171565207W00000X, 207WX0200X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program