ST NICHOLAS MEDICAL GROUP NPI 1891026100

NPI Information

ST NICHOLAS MEDICAL GROUP is a geriatric medicine internal medicine in Los Angeles, CA. The provider is an internist who has special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive and rehabilitative aspects of illness in the elderly. This specialist cares for geriatric patients in the patient's home, the office, long-term care settings such as nursing homes and the hospital. ST NICHOLAS MEDICAL GROUP NPI is 1891026100. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

5520 SANTA MONICA BLVD
SUITE 112
LOS ANGELES, CA
ZIP 90038-932
Phone: (323) 860-9054
Fax: (323) 860-9053

The provider's authorized official is Jacob N Flores .
The authorized official title is Partner and has the following contact phone number (323) 860-9054.

The CLIA number assigned to this NPI record is 05D1070266 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/26/2010 and was last updated on 8/26/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.