MEDICARE: NICOLE SULHAM

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	2251X0800X	Orthopedic Physical Therapist	38223	CA

General Provider Information

NPI Number	:	1619250610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE SULHAM

Provider Business Mailing Address
First Line	:	3218 GOVERNOR DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92122-2902
Country	:	US
Telephone Number	:	858-453-3000
Fax Number	:	858-453-3066

Provider Business Practice Location Address
First Line	:	3218 GOVERNOR DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92122-2902
Country	:	US
Telephone Number	:	858-453-3000
Fax Number	:	858-453-3066

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

Provider Enumeration Date	:	09/26/2011
Last Update Date	:	02/12/2022

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Directions to “ NICOLE SULHAM ” Practice Location

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