Provider Demographics
NPI:1710907811
Name:NICOL, BARBARA (MD)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:NICOL
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 1:3555 CESAR CHAVEZ
Mailing Address - Street 2:LIZETTE WARDELL, ADMINISTRATIVE SERVICES, SLHCC
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-4403
Mailing Address - Country:US
Mailing Address - Phone:415-641-6737
Mailing Address - Fax:415-641-6899
Practice Address - Street 1:3555 CESAR CHAVEZ
Practice Address - Street 2:LIZETTE WARDELL, ADMINISTRATIVE SERVICES, SLHCC
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-4403
Practice Address - Country:US
Practice Address - Phone:415-641-6737
Practice Address - Fax:415-641-6899
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG77616207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G776160Medicare ID - Type Unspecified
CAG31427Medicare UPIN