Individual
PETER W NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1441 EASTLAKE AVE, SUITE 2424, LOS ANGELES, CA 90089-0112
(323) 442-2582
(323) 442-2588
Mailing address
PO BOX 512565, LOS ANGELES, CA 90051-0565
(323) 442-2582
(323) 442-2588
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
G38456
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G384560
BLUE SHIELD
CA
05
—
00G384560
—
CA
01
—
1952325565
GROUP NPI
CA
Enumeration date
08/04/2006
Last updated
03/24/2008
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