MEDICARE: NICKOLAS A TOMASIC MD A PROFESSIONAL CORPORATION

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	208800000X	Urology Physician

General Provider Information

NPI Number	:	1780499012
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NICKOLAS A TOMASIC MD A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	3831 HUGHES AVE STE 606
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90232-6849
Country	:	US
Telephone Number	:	310-425-8060
Fax Number	:	310-425-8260

Provider Business Practice Location Address
First Line	:	3831 HUGHES AVE STE 606
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90232-6849
Country	:	US
Telephone Number	:	310-425-8060
Fax Number	:	310-425-8260

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. NICKOLAS A TOMASIC
Credential	:	MD
Telephone Number	:	310-425-8060

Provider Enumeration Date	:	02/12/2025
Last Update Date	:	07/01/2025

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