MEDICARE: NICKOLAS PETER GRIMES DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	E6064	CA

General Provider Information

NPI Number	:	1013594308
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICKOLAS PETER GRIMES DPM

Provider Business Mailing Address
First Line	:	24 DAISY ST
Second Line	:
City	:	LADERA RANCH
State	:	CA
Zip	:	92694-0709
Country	:	US
Telephone Number	:	949-291-6369
Fax Number	:	949-388-8448

Provider Business Practice Location Address
First Line	:	310 S HALCYON RD
Second Line	:
City	:	ARROYO GRANDE
State	:	CA
Zip	:	93420-3872
Country	:	US
Telephone Number	:	510-917-2334
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2021
Last Update Date	:	06/13/2024

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Directions to “ NICKOLAS PETER GRIMES DPM” Practice Location

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