Doctor Name: | BEATA A NICKEL |
NPI Number: | 1154607000 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MD, PHD |
License Number: | A51219 |
Business Practice Address: | 18111 Coastline Dr Apt 4 Malibu, CA - 902655746 |
Business Phone Number: | 3102304000 |
Business Fax Number: | 3104541988 |
Mailing Address: | 18111 Coastline Dr 4, MALIBU |
State: | CA |
Postal Code: | 90265 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 10/24/2011 |
NPI Last Update Date: | 10/24/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | A51219 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |