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General NPI Number Information
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NPI Number | 1083135933
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Entity Type | Individual
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Provider Name | NICOLE GUIRGUIS DDS
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Gender | Female
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Dates
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Enumeration Date | 06/30/2017
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Last Update Date | 12/05/2019
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Provider Practice Location Address
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Address Line | 8301 IMPERIAL HWY
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City | DOWNEY
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State | CA
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Zip | 90242-3830
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Country | US
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Telephone | 562-273-3207
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Fax |
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Provider Business Mailing Address
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Address Line | 4139 VIA MARINA APT 810
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City | MARINA DEL REY
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State | CA
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Zip | 90292-5365
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Country | US
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Telephone | 631-455-9521
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Fax |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 103780
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 10570
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License Number State | TN
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