Healthcare Provider Details

I. General information

NPI: 1366189938
Provider Name (Legal Business Name): NICOLE WARD, A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2022
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2063 S. ATLANTIC BLVD, SUITE 300
MONTEREY PARK CA
91754
US

IV. Provider business mailing address

2629 FOOTHILL BLVD # 305
LA CRESCENTA CA
91214-3511
US

V. Phone/Fax

Practice location:
  • Phone: 818-806-8830
  • Fax: 818-536-7695
Mailing address:
  • Phone: 818-806-8830
  • Fax: 818-536-7695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name: NICOLE KENDALL WARD
Title or Position: OWNER
Credential: DO
Phone: 310-473-9400