Lamar Ray Nicholson

Individual provider Active NPI Attendant Care Provider · Adelanto, CA

NPI 1891380705 · NPPES record last updated Mar 2, 2021

Key facts

NPI
1891380705
Entity type
Individual (NPI type 1)
Primary specialty
Attendant Care Provider 3747A0650X
Practice address
10478 Thorndale St
Adelanto, CA 92301-4887
Phone
(909) 730-5136
NPI assigned
Mar 2, 2021
Sex
Male
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Attendant Care Provider 3747A0650X Yes

Addresses

Primary practice location

10478 Thorndale St
Adelanto, CA 92301-4887

Mailing address

10478 Thorndale St
Adelanto, CA 92301-4887
Phone (909) 730-5136

Other providers in Adelanto, CA

All providers in Adelanto, CA · Attendant Care Provider in California

Sources for this page

Verify at the official NPI Registry.