Provider Demographics
NPI:1952749301
Name:LERIAS, NICHOLAS (DO)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:
Last Name:LERIAS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 S MILLS AVE
Mailing Address - Street 2:205W
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95242-4241
Mailing Address - Country:US
Mailing Address - Phone:631-223-8558
Mailing Address - Fax:
Practice Address - Street 1:1511 S MILLS AVE
Practice Address - Street 2:205W
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242-4241
Practice Address - Country:US
Practice Address - Phone:631-223-8558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-07
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14561208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics