Provider Demographics
NPI:1760562458
Name:O'DONNELL, NICHOLAS CHRISTIAN (LAC)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:CHRISTIAN
Last Name:O'DONNELL
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:335 ARLINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94131-3013
Mailing Address - Country:US
Mailing Address - Phone:415-412-8841
Mailing Address - Fax:
Practice Address - Street 1:862 FOLSOM ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94107-1123
Practice Address - Country:US
Practice Address - Phone:415-412-8841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC9133171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist