Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | E1885 | CA |
N | 222Z00000X | Podiatrist | E1885 | CA |
N | 2081S0010X | Sports Medicine | E1885 | CA |
N | 213ES0000X | Sports Medicine | E1885 | CA |
NPI | 1225148794 |
---|---|
Provider Name | Dr. James George Nickolopoulos |
First Address | San Francisco, CA 94122-1618 |
Second Address | San Francisco, CA 94122-1618 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000E18850 | (05) | CA |
T11090 | (02) |