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General NPI Number Information
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NPI Number | 1720962715
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Entity Type | Organization
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Legal Business Name | NICKOLAS GRIMES, DPM, PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 08/02/2025
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Last Update Date | 08/02/2025
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Provider Practice Location Address
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Address Line | 310 S HALCYON RD STE 101
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City | ARROYO GRANDE
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State | CA
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Zip | 93420-3863
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Country | US
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Telephone | 805-481-0881
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Fax |
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Provider Business Mailing Address
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Address Line | 1401 21ST ST # 10248
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City | SACRAMENTO
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State | CA
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Zip | 95811-5226
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Country | US
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Telephone | 805-362-9600
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | NICKOLAS GRIMES
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Credential | DPM
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Telephone | 805-362-9600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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