Healthcare Provider Details

I. General information

NPI: 1154717619
Provider Name (Legal Business Name): NICKI VITHALANI RAO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICKI DINESH VITHALANI MD

II. Dates (important events)

Enumeration Date: 04/11/2015
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 GROSSMONT CENTER DR
LA MESA CA
91942-3019
US

IV. Provider business mailing address

5555 GROSSMONT CENTER DR ATTN AIM/PALLIATIVE CARE
SAN DIEGO CA
91942
US

V. Phone/Fax

Practice location:
  • Phone: 619-740-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberMD467593
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number151429
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: