Healthcare Provider Details

I. General information

NPI: 1427145218
Provider Name (Legal Business Name): STEPHEN P. NICHOLS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 01/11/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 SANTA FE DR. SUITE 100
ENCINITAS CA
92024
US

IV. Provider business mailing address

351 SANTA FE DR. SUITE 100
ENCINITAS CA
92024
US

V. Phone/Fax

Practice location:
  • Phone: 760-633-3130
  • Fax: 760-633-3546
Mailing address:
  • Phone: 760-633-3130
  • Fax: 760-633-3546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberG57814
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: