Provider Demographics
NPI:1164627832
Name:HIBBS, NICOLE M (MD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:M
Last Name:HIBBS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:MARIE
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:550 WASHINGTON ST
Mailing Address - Street 2:STE 300
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-2227
Mailing Address - Country:US
Mailing Address - Phone:619-297-5437
Mailing Address - Fax:619-243-0722
Practice Address - Street 1:550 WASHINGTON ST
Practice Address - Street 2:STE 300
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2227
Practice Address - Country:US
Practice Address - Phone:619-297-5437
Practice Address - Fax:619-243-0722
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA106600174400000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No174400000XOther Service ProvidersSpecialist