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NPI Code Detail

MEDICARE: MRS. GALINA VLADIMIROVNA NIKOLSKAYA M.D.

MEDICARE: MRS. GALINA VLADIMIROVNA NIKOLSKAYA 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
12084N0400XNeurology PhysicianA119235CA

General Provider Information

NPI Number : 1457620965
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. GALINA VLADIMIROVNA NIKOLSKAYA M.D.
Provider Business Mailing Address
First Line : 200 W ARBOR DR
Second Line : 8465
City : SAN DIEGO
State : CA
Zip : 92103-9000
Country : US
Telephone Number : 619-543-3500
Fax Number : 619-543-6806
Provider Business Practice Location Address
First Line : 200 W ARBOR DR
Second Line : 8465
City : SAN DIEGO
State : CA
Zip : 92103-9000
Country : US
Telephone Number : 619-543-3500
Fax Number : 619-543-6806
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/29/2011
Last Update Date : 12/29/2011

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