Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | G38262 | CA |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | G38262 | CA |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | G38262 | CA |
N | 207XX0801X | Orthopaedic Trauma Surgeon | G38262 | CA |
NPI | 1184736480 |
---|---|
Provider Name | Frederic G Nicola |
First Address | Marina Del Rey, CA 90292-6358 |
Second Address | Marina Del Rey, CA 90292-6358 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 14/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
953951031 | TAX ID (01) | CA |