Individual provider · Type 1 NPI
Mervyn Bertrand Nicholas, PA
Medical Physician Assistant · Vallejo, CA
NPI number
1104854728
Active
Practice location
5505 Bordeaux Ct
Vallejo, CA 94591-6308
Fax (925) 372-2804
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Medical Physician Assistant Primary | 363AM0700X | PA15023 (CA) |
Medical Physician Assistant: Definition to come...
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About NPI 1104854728
Mervyn Bertrand Nicholas, PA's National Provider Identifier is 1104854728, issued on Jun 30, 2006. The primary taxonomy on file is Medical Physician Assistant (363AM0700X), and the practice location is in Vallejo, CA. The record was last updated on Jul 8, 2007.