Organization
PACIFIC ORTHOPAEDICS & SPORTS MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN P. NICHOLS M.D. (PARTNER)
(760) 633-3130
Entity
Organization
Contact information
Practice address
351 SANTA FE DR, SUITE 100, ENCINITAS, CA 92024-5137
(760) 633-3130
(760) 633-3546
Mailing address
PO BOX 1240, CARDIFF, CA 92007-7240
(760) 633-3130
(760) 633-3546
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ62507Z
BLUE SHIELD
CA
Enumeration date
11/22/2006
Last updated
03/19/2009
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