Provider Demographics
NPI:1932133253
Name:HERBERT, NICHOLE (MD)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:
Last Name:HERBERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 FOREST LN
Mailing Address - Street 2:
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-4403
Mailing Address - Country:US
Mailing Address - Phone:650-556-1367
Mailing Address - Fax:
Practice Address - Street 1:700 IRWIN ST STE 102
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3300
Practice Address - Country:US
Practice Address - Phone:415-460-9927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG074572207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology