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NPI Code Detail

MEDICARE: NICOLE ANN PABLO

MEDICARE:   NICOLE ANN PABLO
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 AssistantPA58305CA

General Provider Information

NPI Number : 1952929887
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE ANN PABLO
Provider Business Mailing Address
First Line : 273 TELOMA DR
Second Line :
City : VENTURA
State : CA
Zip : 93003-2139
Country : US
Telephone Number : 805-340-0972
Fax Number :
Provider Business Practice Location Address
First Line : 1700 N ROSE AVE STE 320
Second Line :
City : OXNARD
State : CA
Zip : 93030-7648
Country : US
Telephone Number : 805-485-8709
Fax Number : 805-485-5521
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2020
Last Update Date : 07/07/2020

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Directions to “ NICOLE ANN PABLO ” Practice Location

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