Organization
CHILDRENS CLINIC, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL W NICHOLS MD (PRESIDENT)
(505) 662-4234
Entity
Organization
Contact information
Practice address
3917 WEST RD, SUITE 128, LOS ALAMOS, NM 87544-2275
(505) 662-4234
(505) 662-7894
Mailing address
3917 WEST RD, SUITE 128, LOS ALAMOS, NM 87544-2275
(505) 662-4234
(505) 662-7894
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
51342
—
NM
Enumeration date
04/26/2007
Last updated
08/22/2020
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