Basic Information
Provider Information
NPI: 1003001017
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NICHOLS
FirstName: LAWRENCE
MiddleName: MARTIN
NamePrefix: DR.
NameSuffix:  
Credential: M.D
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5471 LA PALMA AVE
Address2: STE. 202
City: LA PALMA
State: CA
PostalCode: 906231745
CountryCode: US
TelephoneNumber: 7145222041
FaxNumber: 7145228246
Practice Location
Address1: 5471 LA PALMA AVE
Address2: STE. 202
City: LA PALMA
State: CA
PostalCode: 906231745
CountryCode: US
TelephoneNumber: 7145222041
FaxNumber: 7145228246
Other Information
ProviderEnumerationDate: 09/12/2007
LastUpdateDate: 09/23/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207N00000XA23444CAY Allopathic & Osteopathic PhysiciansDermatology 

No ID Information.


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