Nicola Medical Center

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

NICOLA MEDICAL CENTER

Practice address

1718 Colorado Blvd Ste a
Los Angeles, CA 90041-1338

Phone

(323) 274-4710

Fax

(323) 274-4709

NPI assigned

Jun 25, 2024

Organization subpart

No

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

Authorized official

Name

Dr. Nicholas Nick Dzebolo, MD

Title

Chief Executive Officer

Phone

(323) 274-4710

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1719273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719273600000",
    "number": "1841035615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1718 COLORADO BLVD STE A",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900411338",
            "telephone_number": "323-274-4710",
            "fax_number": "323-274-4709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1718 COLORADO BLVD STE A",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900411338",
            "telephone_number": "323-274-4710",
            "fax_number": "323-274-4709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NICOLA MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-25",
        "last_updated": "2024-06-25",
        "certification_date": "2024-06-25",
        "status": "A",
        "authorized_official_last_name": "DZEBOLO",
        "authorized_official_first_name": "NICHOLAS",
        "authorized_official_middle_name": "NICK",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "323-274-4710",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leigh Grossman Nickoll
• Grace Aurore Nicksa, M.D.
• Maria C. Nicodemo de Gallo, LMFT
• Jared Nicol
• Nicola Azar MD, Inc
• Lisa Nicola
• Luciano Nicolaci
• Rachael Wiley Nicolaisen, DPT
• Despina Colette Nicolaou, M.S.
• Beatriz Nicolas Jimenez, ACSW

• General Practice Physician in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• General Practice Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2024; 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.