Provider Demographics
NPI:1821133687
Name:OLOW, NICHOLAS PETER (LAC)
Entity Type:Individual
Prefix:MS
First Name:NICHOLAS
Middle Name:PETER
Last Name:OLOW
Suffix:
Gender:M
Credentials:LAC
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Mailing Address - Street 1:4417 30TH ST
Mailing Address - Street 2:SUITE 111
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-4284
Mailing Address - Country:US
Mailing Address - Phone:619-405-5282
Mailing Address - Fax:619-450-4368
Practice Address - Street 1:4417 30TH ST
Practice Address - Street 2:SUITE 111
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92116-4284
Practice Address - Country:US
Practice Address - Phone:619-405-5282
Practice Address - Fax:619-450-4368
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAAC10086171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist