Provider Demographics
NPI:1417255316
Name:FREDERIC G NICOLA, MD, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:FREDERIC G NICOLA, MD, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FREDERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:NICOLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-574-0487
Mailing Address - Street 1:13160 MINDANAO WAY
Mailing Address - Street 2:STE 300
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-6358
Mailing Address - Country:US
Mailing Address - Phone:310-574-0487
Mailing Address - Fax:
Practice Address - Street 1:13160 MINDANAO WAY
Practice Address - Street 2:STE 300
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-6358
Practice Address - Country:US
Practice Address - Phone:310-574-0487
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FREDERIC G NICOLA, MD, A PROFESSIONAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty