Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | G52624 | CA |
NPI | 1609943513 |
---|---|
Provider Name | Michael P. Mc Nicoll |
First Address | Los Angeles, CA 90027-6021 |
Second Address | Los Angeles, CA 90027-6021 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2006 |
Last Update Date | 30/11/2021 |