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General NPI Number Information
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NPI Number | 1003001017
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Entity Type | Individual
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Provider Name | LAWRENCE MARTIN NICHOLS M.D
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Gender | Male
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Dates
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Enumeration Date | 09/12/2007
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Last Update Date | 09/23/2010
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Provider Practice Location Address
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Address Line | 5471 LA PALMA AVE STE. 202
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City | LA PALMA
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State | CA
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Zip | 90623-1745
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Country | US
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Telephone | 714-522-2041
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Fax | 714-522-8246
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Provider Business Mailing Address
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Address Line | 5471 LA PALMA AVE STE. 202
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City | LA PALMA
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State | CA
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Zip | 90623-1745
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Country | US
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Telephone | 714-522-2041
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Fax | 714-522-8246
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | A23444
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License Number State | CA
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