Individual
SUSANNE BERNADETTE NICHOLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
200 MEDICAL PLAZA, #365,530,420,120, LOS ANGELES, CA 90095
(310) 825-6301
Mailing address
5767 W CENTURY BLVD, SUITE 200, LOS ANGELES, CA 90045-5632
(310) 794-7555
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
G70174
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G701740
—
CA
Enumeration date
07/19/2006
Last updated
07/13/2010
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