Basic Information
| Provider Information | |||||||||
| NPI: | 1023106846 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LAWRENCE M NICHOLS MD INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5471 LA PALMA AVE | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | LA PALMA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906234700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7145222041 | ||||||||
| FaxNumber: | 7145228246 | ||||||||
| Practice Location | |||||||||
| Address1: | 5471 LA PALMA AVE | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | LA PALMA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906234700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7145222041 | ||||||||
| FaxNumber: | 7145228246 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2006 | ||||||||
| LastUpdateDate: | 09/23/2010 | ||||||||
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| AuthorizedOfficialLastName: | NICHOLS | ||||||||
| AuthorizedOfficialFirstName: | LAWRENCE | ||||||||
| AuthorizedOfficialMiddleName: | MARTIN | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7145222041 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | A23444 | CA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.