MEDICARE: DR. NICHOLAS DEGNER MD, MPH

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	207RI0200X	Infectious Disease Physician	A150947	CA
2	207R00000X	Internal Medicine Physician	A150947	CA

General Provider Information

NPI Number	:	1174985451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICHOLAS DEGNER MD, MPH

Provider Business Mailing Address
First Line	:	1724 MONTANA AVE APT 2
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-1917
Country	:	US
Telephone Number	:	619-865-0546
Fax Number	:

Provider Business Practice Location Address
First Line	:	1724 MONTANA AVE APT 2
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-1917
Country	:	US
Telephone Number	:	619-865-0546
Fax Number	:

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

Provider Enumeration Date	:	03/24/2016
Last Update Date	:	08/10/2022

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