Individual
KEITH NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
680 MACON RD, MOFFETT FIELD, CA 94035-1005
(253) 266-3622
Mailing address
680 MACON RD, MOFFETT FIELD, CA 94035-1005
Taxonomy
Speciality
Code
Description
License number
State
146M00000X
Intermediate Emergency Medical Technician
Primary
A2058105
—
Other
Enumeration date
03/16/2026
Last updated
03/16/2026
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