Provider Demographics
NPI:1164392106
Name:NYKIA CHICHIZOLA-PEACE, M.D., P.C.
Entity type:Organization
Organization Name:NYKIA CHICHIZOLA-PEACE, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO,CFO
Authorized Official - Prefix:
Authorized Official - First Name:NYKIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHICHIZOLA-PEACE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-766-3441
Mailing Address - Street 1:40839 MORRIS ST
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92203-3053
Mailing Address - Country:US
Mailing Address - Phone:310-766-3441
Mailing Address - Fax:
Practice Address - Street 1:4326 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90062-1648
Practice Address - Country:US
Practice Address - Phone:310-766-3441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-06
Last Update Date:2025-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA635974Medicaid