Healthcare Provider Details

I. General information

NPI: 1740547744
Provider Name (Legal Business Name): NICOLAS RIPP MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2012
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 S HARBOR BLVD
SANTA ANA CA
92704-7933
US

IV. Provider business mailing address

3401 S HARBOR BLVD
SANTA ANA CA
92704-7933
US

V. Phone/Fax

Practice location:
  • Phone: 833-574-2273
  • Fax:
Mailing address:
  • Phone: 833-574-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA129654
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: