Provider Demographics
NPI:1356453088
Name:NICOLAS DIKIO MD INC
Entity Type:Organization
Organization Name:NICOLAS DIKIO MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:DIKIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-594-0806
Mailing Address - Street 1:3791 KATELLA AVE
Mailing Address - Street 2:STE 209
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3105
Mailing Address - Country:US
Mailing Address - Phone:562-594-0806
Mailing Address - Fax:
Practice Address - Street 1:3791 KATELLA AVE
Practice Address - Street 2:STE 209
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3105
Practice Address - Country:US
Practice Address - Phone:562-594-0806
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40344207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A403442Medicaid
CA00A403441Medicaid
CA00A403440Medicaid
CA00A403441Medicaid
CAW18012Medicare PIN