| Doctor Name: | CLARENCE L NICODEMUS |
| NPI Number: | 1063690535 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PHD DO |
| License Number: | 20A10296 |
| Business Practice Address: | 910 Major Sherman Ln Suite 300 Monterey, CA - 939404642 |
| Business Phone Number: | 8316449614 |
| Business Fax Number: | 8316449615 |
| Mailing Address: | 910 Major Sherman Ln, Suite 300 MONTEREY |
| State: | CA |
| Postal Code: | 939404642 |
| Phone Number: | 8316449614 |
| Fax Number: | 8316449615 |
| NPI Enumeration Date: | 02/06/2008 |
| NPI Last Update Date: | 05/21/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 204D00000X |
| License Number: | 20A10296 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Neuromusculoskeletal Medicine & OMM |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |