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General NPI Number Information
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NPI Number | 1992876155
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Entity Type | Individual
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Provider Name | NICHOLAS P MARSICO M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/10/2006
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Last Update Date | 12/14/2007
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Provider Practice Location Address
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Address Line | 420 E 3RD ST SUITE 603
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City | LOS ANGELES
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State | CA
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Zip | 90013-1644
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Country | US
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Telephone | 213-680-1551
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Fax | 213-680-2148
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Provider Business Mailing Address
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Address Line | 420 E 3RD ST SUITE 603
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City | LOS ANGELES
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State | CA
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Zip | 90013-1644
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Country | US
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Telephone | 213-680-1551
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Fax | 213-680-2148
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | A86442
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License Number State | CA
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