Provider Demographics
NPI:1003005109
Name:FETTMAN, NICHOLAS AARON (MD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:AARON
Last Name:FETTMAN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2876 SYCAMORE DR
Mailing Address - Street 2:SUITE 303
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-1530
Mailing Address - Country:US
Mailing Address - Phone:805-527-7320
Mailing Address - Fax:805-527-2426
Practice Address - Street 1:1700 N ROSE AVE
Practice Address - Street 2:SUITE 460
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-3790
Practice Address - Country:US
Practice Address - Phone:805-983-0395
Practice Address - Fax:805-983-0463
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-15
Last Update Date:2019-11-27
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Provider Licenses
StateLicense IDTaxonomies
CAA116624207Y00000X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFE976ZMedicare PIN