# NICHOLAS J BEVILACQUA D P M INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1265762090
- **Authorized official:** DR. NICHOLAS J BEVILACQUA D.P.M. (OWNER)
- **Authorized official phone:** (818) 902-5755

## Contact information

- **Practice address:** 15107 VANOWEN ST, VAN NUYS, CA 91405-4542
- **Practice address phone:** (818) 902-5755
- **Practice address fax:** (818) 902-5766
- **Mailing address:** 15107 VANOWEN ST, VAN NUYS, CA 91405-4542
- **Mailing address phone:** (818) 902-5755
- **Mailing address fax:** (818) 902-5766

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | E4859 | CA | Yes |

## Other

- **Enumeration date:** 12/29/2009
- **Last updated:** 05/24/2010