Healthcare Provider Details

I. General information

NPI: 1053452300
Provider Name (Legal Business Name): NICOLE AMELIE CHAUCHE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 10/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9974 SCRIPPS RANCH BLVD 363
SAN DIEGO CA
92131-1825
US

IV. Provider business mailing address

9974 SCRIPPS RANCH BLVD 363
SAN DIEGO CA
92131-1825
US

V. Phone/Fax

Practice location:
  • Phone: 858-279-1212
  • Fax: 858-279-1420
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG46606
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberG46606
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: