MEDICARE: NATHANIEL GREGG DENICOLA MD

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	207VG0400X	Gynecology Physician	C170127	CA

General Provider Information

NPI Number	:	1225205651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHANIEL GREGG DENICOLA MD

Provider Business Mailing Address
First Line	:	320 SUPERIOR AVE STE 290
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92663-6140
Country	:	US
Telephone Number	:	949-375-8244
Fax Number	:	949-398-9812

Provider Business Practice Location Address
First Line	:	320 SUPERIOR AVE STE 290
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92663-6140
Country	:	US
Telephone Number	:	949-375-8244
Fax Number	:	949-398-9812

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

Provider Enumeration Date	:	05/14/2008
Last Update Date	:	09/12/2025

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