Healthcare Provider Details

I. General information

NPI: 1083876510
Provider Name (Legal Business Name): MARIALENA JOANNE NICHOLS R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2008
Last Update Date: 06/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 E TEMPLE ST
LOS ANGELES CA
90012-3328
US

IV. Provider business mailing address

351 E TEMPLE ST
LOS ANGELES CA
90012-3328
US

V. Phone/Fax

Practice location:
  • Phone: 213-253-2677
  • Fax:
Mailing address:
  • Phone: 213-253-2677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number292800
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: