Individual
AIKKIKO NICKLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
IDC
Contact information
Practice address
1741 ORO VISTA RD APT 245, SAN DIEGO, CA 92154-4507
(475) 224-8659
Mailing address
1741 ORO VISTA RD APT 245, SAN DIEGO, CA 92154-4507
(475) 224-8659
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
1336722685
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1336722685
TRICARE
—
Enumeration date
05/04/2021
Last updated
01/20/2022
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