Provider Demographics
NPI:1588804801
Name:NICHOLSON, CAROL ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:ELIZABETH
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6461 ZUMA VIEW PL
Mailing Address - Street 2:#149
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-4495
Mailing Address - Country:US
Mailing Address - Phone:310-457-5660
Mailing Address - Fax:
Practice Address - Street 1:6461 ZUMA VIEW PL
Practice Address - Street 2:#149
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-4495
Practice Address - Country:US
Practice Address - Phone:310-457-5660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-26
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG425682080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine