Provider Demographics
NPI:1740616713
Name:SULEIMAN, NICOLE LAURA (MD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:LAURA
Last Name:SULEIMAN
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 1:5461 FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601-5515
Mailing Address - Country:US
Mailing Address - Phone:510-532-0918
Mailing Address - Fax:
Practice Address - Street 1:5461 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601-5515
Practice Address - Country:US
Practice Address - Phone:510-532-0918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-22
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA146873208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics