Mervyn Bertrand Nicholas, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA15023 Issued in CA

Practice address

5505 Bordeaux CT
Vallejo, CA 94591-6308

Phone

(707) 980-0372

Fax

(925) 372-2804

NPI assigned

Jun 30, 2006

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

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Berkeley Emergency Medical Group, Inc.

  • Emergency Medicine Physician
  • Oakland, CA
  • NPI 1508874454
  NPD (past)
• Berkeley Emergency Medical Group, Inc.

  • Emergency Medicine Physician
  • Berkeley, CA
  • NPI 1780692632
  NPD (past)

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

{
    "created_epoch": "1151625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1104854728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5505 BORDEAUX CT",
            "city": "VALLEJO",
            "state": "CA",
            "postal_code": "945916308",
            "telephone_number": "707-980-0372",
            "fax_number": "925-372-2804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5505 BORDEAUX CT",
            "city": "VALLEJO",
            "state": "CA",
            "postal_code": "945916308",
            "telephone_number": "707-980-0372",
            "fax_number": "925-372-2804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLAS",
        "first_name": "MERVYN",
        "middle_name": "BERTRAND",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "PA15023",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sandy Nguyen
• Thien Nguyen
• Traihoa Thi Nguyen, M.D
• Vivian Tran Nguyen
• William Whitmore Nguyen, MA
• Alice Nicholls, M.S., SLP-CF
• Thaleya Nickson
• Sukhranjan Nijjar
• Ermis Nikas, DO
• Loren Abad Niles, PHARMD

• Medical Physician Assistant in Vallejo, CA
• Providers in Vallejo, CA by specialty
• Medical Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.