Organization
BONNIE NICKEL, M.D,
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BONNIE LYNN NICKEL M.D. (OWNER)
(415) 492-0950
Entity
Organization
Contact information
Practice address
750 LAS GALLINAS AVE, SUITE #114, SAN RAFAEL, CA 94903-3438
(415) 492-0950
(415) 492-9029
Mailing address
750 LAS GALLINAS AVE, SUITE #114, SAN RAFAEL, CA 94903-3438
(415) 492-0950
(415) 492-9029
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
00G362480
CA
Other
Enumeration date
11/07/2006
Last updated
10/15/2007
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