Basic Information
| Provider Information | |||||||||
| NPI: | 1003001017 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NICHOLS | ||||||||
| FirstName: | LAWRENCE | ||||||||
| MiddleName: | MARTIN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D | ||||||||
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| 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 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | A23444 | CA | Y | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.