Healthcare Provider Details

I. General information

NPI: 1356373567
Provider Name (Legal Business Name): NICOLE B MULDER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 EAST OHIO AVE
ESCONDIDO CA
92025-3421
US

IV. Provider business mailing address

810 EAST OHIO AVE
ESCONDIDO CA
92025-3421
US

V. Phone/Fax

Practice location:
  • Phone: 760-746-3937
  • Fax: 760-746-3991
Mailing address:
  • Phone: 760-746-3937
  • Fax: 760-746-3991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA75895
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: