Provider Demographics
NPI:1053452300
Name:CHAUCHE, NICOLE AMELIE (MD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:AMELIE
Last Name:CHAUCHE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9974 SCRIPPS RANCH BLVD
Mailing Address - Street 2:363
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-1825
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9974 SCRIPPS RANCH BLVD
Practice Address - Street 2:363
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-1825
Practice Address - Country:US
Practice Address - Phone:858-279-1212
Practice Address - Fax:858-279-1420
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG46606207Q00000X, 207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC04261Medicare UPIN