Healthcare Provider Details

I. General information

NPI: 1982232823
Provider Name (Legal Business Name): NICHOLAS WILLIAM SWART DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2020
Last Update Date: 06/23/2024
Certification Date: 06/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S BUENA VISTA ST
BURBANK CA
91505-4809
US

IV. Provider business mailing address

400 N TUSTIN AVE STE 400
SANTA ANA CA
92705-3850
US

V. Phone/Fax

Practice location:
  • Phone: 818-843-5111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number20A22756
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: