Healthcare Provider Details

I. General information

NPI: 1427481571
Provider Name (Legal Business Name): NICOLE RACHEL MATHEW PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE RACHEL PETER

II. Dates (important events)

Enumeration Date: 08/13/2013
Last Update Date: 05/17/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4312 WOODMAN AVE STE 102
SHERMAN OAKS CA
91423-5523
US

IV. Provider business mailing address

4312 WOODMAN AVE STE 102
SHERMAN OAKS CA
91423-5523
US

V. Phone/Fax

Practice location:
  • Phone: 818-646-2562
  • Fax:
Mailing address:
  • Phone: 818-646-2562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA59606
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: