MEDICARE: DR. NICHOLAS DREGER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080P0202X	Pediatric Cardiology Physician	38421	OK
2	390200000X	Student in an Organized Health Care Education/Training Program
3	2080P0202X	Pediatric Cardiology Physician	A149388	CA

General Provider Information

NPI Number	:	1174902548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICHOLAS DREGER M.D.

Provider Business Mailing Address
First Line	:	11234 ANDERSON ST STE 4439
Second Line	:
City	:	LOMA LINDA
State	:	CA
Zip	:	92354-2804
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11234 ANDERSON ST STE 4439
Second Line	:
City	:	LOMA LINDA
State	:	CA
Zip	:	92354-2804
Country	:	US
Telephone Number	:	909-558-4000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2015
Last Update Date	:	12/28/2023

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