Provider Demographics
NPI:1801188537
Name:GIANDOMENICO, NICOL (ND)
Entity Type:Individual
Prefix:
First Name:NICOL
Middle Name:
Last Name:GIANDOMENICO
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2811 WILSHIRE BLVD
Mailing Address - Street 2:STE 610
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-4803
Mailing Address - Country:US
Mailing Address - Phone:310-453-2335
Mailing Address - Fax:310-453-2337
Practice Address - Street 1:2811 WILSHIRE BLVD
Practice Address - Street 2:STE 610
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-4803
Practice Address - Country:US
Practice Address - Phone:310-453-2335
Practice Address - Fax:310-453-2337
Is Sole Proprietor?:No
Enumeration Date:2011-05-13
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60218338175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath