Provider Demographics
NPI:1336467240
Name:KISSELL, NICOLAS (NICOLAS KISSELL, MD)
Entity Type:Individual
Prefix:DR
First Name:NICOLAS
Middle Name:
Last Name:KISSELL
Suffix:
Gender:M
Credentials:NICOLAS KISSELL, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 ABBOTT ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-4483
Mailing Address - Country:US
Mailing Address - Phone:831-422-3636
Mailing Address - Fax:831-422-1255
Practice Address - Street 1:355 ABBOTT ST STE 200
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-4483
Practice Address - Country:US
Practice Address - Phone:831-422-3636
Practice Address - Fax:831-422-1255
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-17
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA134966207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism