ST NICHOLAS MEDICAL GROUP NPI 1891026100

NPI Information

  • NPI: 1891026100
  • Provider Name: ST NICHOLAS MEDICAL GROUP
  • Classification: Internal Medicine - 207RG0300X
  • Specialization: Geriatric Medicine
  • Entity Type: Organization
  • Address: 5520 SANTA MONICA BLVD
    SUITE 112
    LOS ANGELES, CA
    ZIP 90038
  • Phone: (323) 860-9054

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NPI Details

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 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:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207RG0300XInternal MedicineGeriatric MedicineA60865CALIFORNIAYes

Other Identifiers

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

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1CQ793MEDICARE PINCALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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