Individual
MICHAEL A NICOLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
2501 E CHAPMAN AVE STE 107C, FULLERTON, CA 92831-3132
(562) 304-5150
(562) 317-1073
Mailing address
2501 E CHAPMAN AVE STE 107C, FULLERTON, CA 92831-3132
(562) 304-5150
(562) 317-1073
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
95079457
CA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
95017723
CA
Other
Enumeration date
06/06/2017
Last updated
04/18/2026
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