MEDICARE: NICOLE CLAUDETTE RECORD D.O.

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	207XS0117X	Orthopaedic Surgery of the Spine Physician	20A16278	CA

General Provider Information

NPI Number	:	1659713725
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE CLAUDETTE RECORD D.O.

Provider Business Mailing Address
First Line	:	6190 CORNERSTONE CT E STE 212
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-4701
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6190 CORNERSTONE CT E STE 212
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-4701
Country	:	US
Telephone Number	:	903-383-7295
Fax Number	:

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

Provider Enumeration Date	:	07/18/2013
Last Update Date	:	01/21/2019

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