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General NPI Number Information
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NPI Number | 1295115012
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Entity Type | Individual
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Provider Name | NICHOLAS GOTTERT D.O
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Gender | Male
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Dates
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Enumeration Date | 06/06/2015
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Last Update Date | 09/04/2024
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Provider Practice Location Address
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Address Line | 336 NW 5TH ST
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City | MIAMI
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State | FL
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Zip | 33128-1616
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Country | US
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Telephone | 305-577-4840
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Fax | 305-373-7431
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Provider Business Mailing Address
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Address Line | 2250 W MAIN ST STE 301
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City | ALHAMBRA
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State | CA
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Zip | 91801-1758
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Country | US
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Telephone | 626-457-6900
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 20A17055
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS16567
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License Number State | FL
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