Individual
FREDERIC G NICOLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M. D.
Contact information
Practice address
13160 MINDANAO WAY, STE 300, MARINA DEL REY, CA 90292-6358
(310) 574-0400
(310) 574-0485
Mailing address
13160 MINDANAO WAY, STE 300, MARINA DEL REY, CA 90292-6358
(310) 574-0400
(310) 574-0485
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
G38262
CA
207X00000X
Orthopaedic Surgery Physician
G38262
CA
207XX0004X
Orthopaedic Foot and Ankle Surgery Physician
G38262
CA
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
G38262
CA
207XX0801X
Orthopaedic Trauma Physician
G38262
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
953951031
TAX ID
CA
Enumeration date
08/31/2006
Last updated
04/14/2011
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