Individual
LISA A NICHOLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
200 MEDICAL PLZ, STE 430, LOS ANGELES, CA 90095-0001
(310) 794-7274
Mailing address
5767 W CENTURY BLVD, STE 400, LOS ANGELES, CA 90045-5631
(310) 794-7274
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
A37695
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A376950
MEDI CAL
CA
Enumeration date
07/21/2005
Last updated
04/19/2010
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