Provider Demographics
NPI:1912386400
Name:THALER, NICHOLAS SHIZUO (PHD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:SHIZUO
Last Name:THALER
Suffix:
Gender:M
Credentials:PHD
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Mailing Address - Street 1:5767 W CENTURY BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5631
Mailing Address - Country:US
Mailing Address - Phone:310-206-8100
Mailing Address - Fax:310-301-8751
Practice Address - Street 1:760 WESTWOOD PLZ
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-1759
Practice Address - Country:US
Practice Address - Phone:310-570-5113
Practice Address - Fax:310-301-8751
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-29
Last Update Date:2015-12-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA27149103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist