Healthcare Provider Details

I. General information

NPI: 1316407158
Provider Name (Legal Business Name): NICHOLAS JOSEPH PRINDEZE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

353 W FOOTHILL BLVD
GLENDORA CA
91741-5309
US

IV. Provider business mailing address

353 W FOOTHILL BLVD
GLENDORA CA
91741-5309
US

V. Phone/Fax

Practice location:
  • Phone: 909-757-8425
  • Fax: 909-757-8392
Mailing address:
  • Phone: 909-757-8425
  • Fax: 909-757-8392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA194732
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: