Individual
DOMINIC NICACIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1000 BLYTHE BLVD, CHARLOTTE, NC 28203-5812
(704) 355-3181
(704) 355-7047
Mailing address
932 NE 147TH ST, SHORELINE, WA 98155-7050
(206) 612-3320
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD61405669
WA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/26/2020
Last updated
01/16/2024
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