Provider Demographics
NPI:1265715965
Name:NICHOLE TOMJANOVICH, M.D., P.A.
Entity type:Organization
Organization Name:NICHOLE TOMJANOVICH, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LVN
Authorized Official - Prefix:
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-520-1411
Mailing Address - Street 1:2323 S SHEPHERD DR
Mailing Address - Street 2:SUITE 1012
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77019-7019
Mailing Address - Country:US
Mailing Address - Phone:713-520-1411
Mailing Address - Fax:713-520-1415
Practice Address - Street 1:2323 S SHEPHERD DR
Practice Address - Street 2:SUITE 1012
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77019-7019
Practice Address - Country:US
Practice Address - Phone:713-520-1411
Practice Address - Fax:713-520-1415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM45972084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty