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General NPI Number Information
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NPI Number | 1023106846
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Entity Type | Organization
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Legal Business Name | LAWRENCE M NICHOLS MD INC
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Dates
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Enumeration Date | 10/10/2006
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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 SUITE 202
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City | LA PALMA
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State | CA
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Zip | 90623-4700
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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 SUITE 202
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City | LA PALMA
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State | CA
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Zip | 90623-4700
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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 | PRESIDENT
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Name | DR. LAWRENCE MARTIN NICHOLS
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Credential | MD
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Telephone | 714-522-2041
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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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