Healthcare Provider Details

I. General information

NPI: 1972133080
Provider Name (Legal Business Name): LOUIS NIKOLIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2020
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4860 Y ST STE 3020
SACRAMENTO CA
95817-2307
US

IV. Provider business mailing address

4860 Y ST STE 3020
SACRAMENTO CA
95817-2307
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-6688
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberA201329
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: