Healthcare Provider Details

I. General information

NPI: 1750660445
Provider Name (Legal Business Name): NICKOLAS ALLEN WESTBERG IDC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2011
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USS AMERICA (LHA-6) UNIT 100233
FPO AP
96660
US

IV. Provider business mailing address

USS AMERICA (LHA-6) UNIT 100233
FPO AP
96660
US

V. Phone/Fax

Practice location:
  • Phone: 619-556-5224
  • Fax:
Mailing address:
  • Phone: 619-556-5224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: