Healthcare Provider Details

I. General information

NPI: 1588478093
Provider Name (Legal Business Name): ALICIA DANIELLE NICHOLS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2025
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 SANTEE ST
LOS ANGELES CA
90014-2208
US

IV. Provider business mailing address

300 E HILLCREST BLVD UNIT 1456
INGLEWOOD CA
90308-1826
US

V. Phone/Fax

Practice location:
  • Phone: 213-537-0306
  • Fax:
Mailing address:
  • Phone: 323-816-2455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: