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General NPI Number Information
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NPI Number | 1104834142
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Entity Type | Individual
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Provider Name | PETER W NICHOLS MD
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Gender | Male
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Dates
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Enumeration Date | 08/04/2006
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Last Update Date | 03/24/2008
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Provider Practice Location Address
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Address Line | 1441 EASTLAKE AVE SUITE 2424
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City | LOS ANGELES
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State | CA
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Zip | 90089-0112
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Country | US
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Telephone | 323-442-2582
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Fax | 323-442-2588
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Provider Business Mailing Address
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Address Line | PO BOX 512565
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City | LOS ANGELES
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State | CA
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Zip | 90051-0565
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Country | US
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Telephone | 323-442-2582
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Fax | 323-442-2588
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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 | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | G38456
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License Number State | CA
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