Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | A107640 | CA |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | A107640 | CA |
NPI | 1295930915 |
---|---|
Provider Name | Dr. Nicholas Olson |
First Address | San Diego, CA 92127-5705 |
Second Address | La Jolla, CA 92037-1205 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2007 |
Last Update Date | 10/07/2019 |