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General NPI Number Information
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NPI Number | 1932406907
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Entity Type | Individual
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Provider Name | BROOKE ANN NICHOLS M.D.
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Gender | Female
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Dates
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Enumeration Date | 02/27/2011
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Last Update Date | 12/31/2024
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Provider Practice Location Address
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Address Line | 27799 MEDICAL CENTER RD STE 460
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City | MISSION VIEJO
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State | CA
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Zip | 92691-6400
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Country | US
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Telephone | 949-365-2387
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Fax | 949-365-2356
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Provider Business Mailing Address
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Address Line | 27799 MEDICAL CENTER RD STE 460
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City | MISSION VIEJO
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State | CA
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Zip | 92691-6400
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Country | US
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Telephone | 949-365-2387
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Fax | 949-365-2356
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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 | 207RH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Internal Medicine) Physician
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License Number | 265737
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207RH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Internal Medicine) Physician
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License Number | A138972
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License Number State | CA
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