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NPI Code Detail

MEDICARE: NICOLE WHITNEY MARK

MEDICARE: NICOLE WHITNEY MARK
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
1363AM0700XMedical Physician Assistant
2363A00000XPhysician Assistant57109CA
3363AM0700XMedical Physician Assistant57109CA

General Provider Information

NPI Number : 1609428598
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE WHITNEY MARK
Provider Business Mailing Address
First Line : FILE 57326
Second Line :
City : LOS ANGELES
State : CA
Zip : 90074-7326
Country : US
Telephone Number : 800-926-8273
Fax Number :
Provider Business Practice Location Address
First Line : 200 W ARBOR DR
Second Line :
City : SAN DIEGO
State : CA
Zip : 92103-9000
Country : US
Telephone Number : 800-926-8273
Fax Number : 888-539-8781
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2019
Last Update Date : 02/17/2026

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Directions to “ NICOLE WHITNEY MARK ” Practice Location

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