Provider Demographics
NPI:1851157531
Name:NICOLA NATSIS M.D., INC.
Entity Type:Organization
Organization Name:NICOLA NATSIS M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:NATSIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-714-7743
Mailing Address - Street 1:1901 AVENUE OF THE STARS STE 1800
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-6019
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8920 WILSHIRE BLVD STE 545
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2009
Practice Address - Country:US
Practice Address - Phone:310-854-3003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty