Individual
KENNETH NICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
4445 MAGNOLIA AVE, RIVERSIDE, CA 92501-4135
(909) 788-3000
Mailing address
2100 POWELL ST, STE 900, EMERYVILLE, CA 94608-1826
(510) 350-2600
(510) 879-9100
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
C33985
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00C339850
—
CA
Enumeration date
08/21/2006
Last updated
07/18/2008
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