Healthcare Provider Details

I. General information

NPI: 1124203583
Provider Name (Legal Business Name): NICHOLAS ANDREW ROGERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2008
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41250 12TH ST W STE B
PALMDALE CA
93551-1444
US

IV. Provider business mailing address

41250 12TH ST W STE B
PALMDALE CA
93551-1444
US

V. Phone/Fax

Practice location:
  • Phone: 661-499-2720
  • Fax: 661-499-2721
Mailing address:
  • Phone: 661-499-2720
  • Fax: 661-499-2721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA112189
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: