Samuel Alvin Nicolas IV, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

132210 Issued in CA

Practice address

34800 Bob Wilson Dr
San Diego, CA 92134-1098

Phone

(619) 532-6210

Fax

(619) 532-5477

NPI assigned

Feb 27, 2013

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1361923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614211200000",
    "number": "1083954051",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34800 BOB WILSON DR",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921345000",
            "telephone_number": "619-532-6210",
            "fax_number": "619-532-5477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34800 BOB WILSON DR",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921341098",
            "telephone_number": "619-532-6210",
            "fax_number": "619-532-5477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICOLAS",
        "first_name": "SAMUEL",
        "middle_name": "ALVIN",
        "name_suffix": "IV",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-02-27",
        "last_updated": "2021-02-25",
        "certification_date": "2021-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "132210",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Adelle Nicolas, FNP
• Dalia Nicolas
• Fadi J Nicolas, MD
• Jorene Nicolas, RCP
• Karla Angelica Nicolas, APCC
• Nicole Monsowitz Counseling Services
• Nicole Monsowitz Licensed Clinical Social Worker Inc.
• Brad James Nicoll, P.T.
• Jessica Nicolosi
• Francesca Berhau Nicosia

• Psychiatry Physician in San Diego, CA
• Providers in San Diego, CA by specialty
• Psychiatry Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.