Provider Demographics
NPI:1841388279
Name:NUTTALL, NICOLAS JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:NICOLAS
Middle Name:JOHN
Last Name:NUTTALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2 UPPER RAGSDALE DR
Mailing Address - Street 2:B220
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-5736
Mailing Address - Country:US
Mailing Address - Phone:831-646-1160
Mailing Address - Fax:831-646-1151
Practice Address - Street 1:2 UPPER RAGSDALE DR
Practice Address - Street 2:B220
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-5736
Practice Address - Country:US
Practice Address - Phone:831-646-1160
Practice Address - Fax:831-646-1151
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG69767207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF11798Medicare UPIN
CA00G697670Medicare ID - Type Unspecified