| Doctor Name: | MR. PETER JOHN NICIFOROS |
| NPI Number: | 1356359277 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | C26175 |
| Business Practice Address: | 9190 Haven Ave Suite # 102 Rancho Cucamonga, CA - 917305431 |
| Business Phone Number: | 9095278110 |
| Business Fax Number: | 9095816738 |
| Mailing Address: | 840 Towne Center Dr, Chaparral Medical Group, Inc. POMONA |
| State: | CA |
| Postal Code: | 917675900 |
| Phone Number: | 9093981550 |
| Fax Number: | 9093981573 |
| NPI Enumeration Date: | 08/04/2006 |
| NPI Last Update Date: | 01/29/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | C26175 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |