| Organization Name: | NICODEMUS MEDICAL CORPORATION |
| NPI Number: | 1083026397 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CLARENCE LYN NICODEMUS (PRESIDENT, MEDICAL DIRECTOR) |
| Mailing Address: | 910 Major Sherman Ln Suite 300 Monterey |
| State: | CA US |
| Postal Code: | 939404642 |
| Phone Number: | 8316649614 |
| Fax Number: | 8316449615 |
| NPI Enumeration Date: | 05/21/2014 |
| NPI Last Update Date: | 01/14/2015 |
| 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: | |