Basic Information
| Provider Information | |||||||||
| NPI: | 1124000211 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOLMES | ||||||||
| FirstName: | NICHOLAS | ||||||||
| MiddleName: | MATTHEW | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3860 CALLE FORTUNADA | ||||||||
| Address2: | STE#210 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921234802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8583096303 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7920 FROST ST | ||||||||
| Address2: | STE 200 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921232736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8582798527 | ||||||||
| FaxNumber: | 8589668479 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2005 | ||||||||
| LastUpdateDate: | 11/16/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | G84322 | CA | N | Allopathic & Osteopathic Physicians | Urology | 2088P0231X | G84322 | CA | Y | Allopathic & Osteopathic Physicians | Urology | Pediatric Urology |
No ID Information.