# FREDERIC G NICOLA, MD, A PROFESSIONAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** FREDERIC G NICOLA, MD, A PROFESSIONAL CORPORATION
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1417254459
- **Legal business name:** FREDERIC G NICOLA, MD, A PROFESSIONAL CORPORATION
- **Authorized official:** FREDERIC NICOLA MD (PRESIDENT)
- **Authorized official phone:** (310) 574-0487

## Contact information

- **Practice address:** 13160 MINDANAO WAY, STE 300, MARINA DEL REY, CA 90292-6358
- **Practice address phone:** (310) 574-0487
- **Mailing address:** 2980 N BEVERLY GLEN CIR, STE 301, LOS ANGELES, CA 90077-1726
- **Mailing address phone:** (310) 474-9809

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332900000X | Non-Pharmacy Dispensing Site | — | NULL | Yes |

## Other

- **Enumeration date:** 02/25/2011
- **Last updated:** 02/25/2011