JACK LEE NICHOLSON I (NPI# 1831748318) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1831748318 |
Entity Type | Individual |
Full Name | JACK LEE NICHOLSON I |
Practice Address |
460 Aztec Ln Lathrop CA 95330-9142 |
Practice Telephone | 2094518732 |
Enumeration Date | 2019-09-08 |
Last Update Date | 2019-09-08 |
Gender Code | M |
Is Sole Proprietor | Y |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 3747A0650X |
Technician Specialization: Attendant Care Provider |
CA | Nursing Service Related Providers | |
N | 3747A0650X |
Technician Specialization: Attendant Care Provider |
Nursing Service Related Providers |
State | Issuer | Identifier | Type Code |
---|---|---|---|
CA | 3747A0650X | 05 | |
CA | 193200000X | 05 | |
CA | 1933200000X | 05 |
Street Address |
460 AZTEC LN |
City | LATHROP |
State | CA |
Zip Code | 95330-9142 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1861919938 | Lathrop Pharmacy, LLC. | Pharmacy | 201 E. Louise Ave, Lathrop, CA 95330 | 2017-08-29 |
1063936052 | Japneet S Dhillon Dds Inc | Dentist | 15366 S Harlan Rd, Lathrop, CA 95330 | 2017-08-01 |
1992966253 | Garfield Beach Cvs LLC | Durable Medical Equipment & Medical Supplies | 16858 Golden Valley Pkwy, Lathrop, CA 95330 | 2008-06-19 |
1508023235 | Marysol B. Realon Dds A Prof. Dental Corp | Dentist | 259 E. Louise Ave, Lathrop, CA 95330 | 2008-05-20 |
1104048107 | Myduyen Tran | Dentist | 15136 Harlan Rd., Lathrop, CA 95330 | 2007-05-02 |
1043689193 | Joy Viscia Victoria Bareng | Pharmacist | 16858 Golden Valley Pkwy, Lathrop, CA 95330 | 2015-09-18 |
1851645287 | Amarpreet Kaur Sidhu | Pharmacist | 16858 Golden Valley Parkway, Lathrop, CA 95330 | 2012-11-07 |
1275801946 | Han Nguyen | Pharmacist | 16858 Golden Valley Pkwy, T2347, Lathrop, CA 95330 | 2011-12-08 |
1184910820 | Jennifer Leung | Pharmacist | 16858 Golden Valley Parkway, T-2347, Lathrop, CA 95330-7296 | 2011-06-21 |
1154959666 | Edgar D Lardizabal | Registered Nurse | 1705 Cranbrook Ct, Lathrop, CA 95330-8244 | 2020-03-30 |
Find all providers in zip 95330 |
Taxonomy Code | 3747A0650X |
Grouping | Nursing Service Related Providers |
Classification | Technician |
Specialization | Attendant Care Provider |
An individual who provides hands-on care, of both a supportive and health related nature, specific to the needs of a medically stable, physically handicapped individual. Supportive services are those that substitute for the absence, loss, diminution, or impairment of a physical or cognitive function. This service may include skilled or nursing care to the extent permitted by state law. |
Notes: [7/1/2003: new] |
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1750991667 | Natalie Mari Norman | Technician | 5013 Englewood Dr, San Jose, CA 95129-4232 | 2020-08-05 |
Find all providers with the same taxonomy |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.