Provider Demographics
NPI:1881821122
Name:UNDERWOOD, NICOLLE (MD)
Entity Type:Individual
Prefix:DR
First Name:NICOLLE
Middle Name:
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:NICOLLE
Other - Middle Name:
Other - Last Name:GORBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:500 SUPERIOR AVENUE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3609
Mailing Address - Country:US
Mailing Address - Phone:949-644-2722
Mailing Address - Fax:949-760-5438
Practice Address - Street 1:500 SUPERIOR AVENUE
Practice Address - Street 2:SUITE 310
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3609
Practice Address - Country:US
Practice Address - Phone:949-644-2722
Practice Address - Fax:949-760-5438
Is Sole Proprietor?:No
Enumeration Date:2009-06-14
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA145047207V00000X
NY269054207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics