Provider Demographics
NPI:1003890666
Name:NICHOLS, ALPHONSO III (MD)
Entity type:Individual
Prefix:DR
First Name:ALPHONSO
Middle Name:
Last Name:NICHOLS
Suffix:III
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10755 SCRIPPS POWAY PKWY # 455
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-3924
Mailing Address - Country:US
Mailing Address - Phone:858-412-7362
Mailing Address - Fax:858-368-9797
Practice Address - Street 1:9750 MIRAMAR RD STE 200
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-4562
Practice Address - Country:US
Practice Address - Phone:858-412-7362
Practice Address - Fax:858-368-9797
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC1771092084P0804X, 2084P0800X
KY394382084P0804X
IN01061506A2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYG99684Medicare UPIN