Healthcare Provider Details

I. General information

NPI: 1548273758
Provider Name (Legal Business Name): NICHOLAS ABIDI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 11/06/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4140 JADE ST STE 100
CAPITOLA CA
95010-3940
US

IV. Provider business mailing address

PO BOX 31396
WALNUT CREEK CA
94598-8396
US

V. Phone/Fax

Practice location:
  • Phone: 831-475-4024
  • Fax: 831-475-4344
Mailing address:
  • Phone: 925-939-8585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberG85551
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberG85551
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License NumberG85551
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: