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General NPI Number Information
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NPI Number | 1588726624
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Entity Type | Organization
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Legal Business Name | JAMES R. NICKEL, M.D., INC
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 03/26/2013
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Provider Practice Location Address
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Address Line | 9355 CHAPMAN AVE., SUITE 102
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City | GARDEN GROVE
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State | CA
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Zip | 92841-4306
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Country | US
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Telephone | 619-757-4211
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Fax | 619-226-2805
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Provider Business Mailing Address
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Address Line | 9355 CHAPMAN AVE., SUITE 102
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City | GARDEN GROVE
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State | CA
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Zip | 92841-4306
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Country | US
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Telephone | 619-757-4211
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Fax | 619-226-2805
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Authorized Official
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Title or Position | OWNER / DIRECTOR
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Name | DR. JAMES R. NICKEL
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Credential | M.D.
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Telephone | 619-757-4211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | CLF11502
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License Number State | CA
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