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General NPI Number Information
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NPI Number | 1982482089
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Entity Type | Individual
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Provider Name | ELIZABETH NICOLAS DDS
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Gender | Female
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Dates
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Enumeration Date | 09/19/2023
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Last Update Date | 02/04/2025
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Provider Practice Location Address
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Address Line | 18601 VALLEY BLVD
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City | BLOOMINGTON
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State | CA
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Zip | 92316-1831
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Country | US
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Telephone | 951-571-2300
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Fax |
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Provider Business Mailing Address
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Address Line | 140 E EL NORTE PKWY UNIT 67
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City | ESCONDIDO
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State | CA
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Zip | 92026-2624
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Country | US
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Telephone |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 109263
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License Number State | CA
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