1821133687 NPI number — MS. NICHOLAS PETER OLOW L.A.C

Table of content: MS. NICHOLAS PETER OLOW L.A.C (NPI 1821133687)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821133687 NPI number — MS. NICHOLAS PETER OLOW L.A.C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OLOW
Provider First Name:
NICHOLAS
Provider Middle Name:
PETER
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
L.A.C
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821133687
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/03/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4417 30TH ST
Provider Second Line Business Mailing Address:
SUITE 111
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92116-4284
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-405-5282
Provider Business Mailing Address Fax Number:
619-450-4368

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4417 30TH ST
Provider Second Line Business Practice Location Address:
SUITE 111
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92116-4284
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-405-5282
Provider Business Practice Location Address Fax Number:
619-450-4368
Provider Enumeration Date:
02/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  AC10086 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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