Healthcare Provider Details

I. General information

NPI: 1689134348
Provider Name (Legal Business Name): NICHOLAS EDWARD BOHRER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 EUCLID AVE STE 304
NATIONAL CITY CA
91950-2974
US

IV. Provider business mailing address

5222 BALBOA AVE FL 5
SAN DIEGO CA
92117-6904
US

V. Phone/Fax

Practice location:
  • Phone: 619-267-8303
  • Fax: 619-267-4835
Mailing address:
  • Phone: 619-267-8303
  • Fax: 619-267-4835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License NumberA182042
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number4053
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: