Healthcare Provider Details

I. General information

NPI: 1407809189
Provider Name (Legal Business Name): CARRIE J. NICHOLS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 02/07/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MERCY CIRCLE FAMILY MEDICINE DEPT
CAMP PENDLETON CA
92058
US

IV. Provider business mailing address

200 MERCY CIRCLE FAMILY MEDICINE DEPT
CAMP PENDLETON CA
92058
US

V. Phone/Fax

Practice location:
  • Phone: 760-719-3616
  • Fax: 760-725-1101
Mailing address:
  • Phone: 760-719-3616
  • Fax: 760-725-1101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA83442
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA83442
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: