Healthcare Provider Details

I. General information

NPI: 1740372861
Provider Name (Legal Business Name): NICHOLAS S MUFF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 E ONTARIO AVE STE 101
CORONA CA
92879-3508
US

IV. Provider business mailing address

P O BOX 977
COUPEVILLE WA
98239
US

V. Phone/Fax

Practice location:
  • Phone: 949-490-4820
  • Fax: 949-490-4819
Mailing address:
  • Phone: 360-678-4071
  • Fax: 360-678-6014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberG25544
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD00015015
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: