Provider Demographics
NPI:1366972564
Name:WARD, NICOLE KENDALL (DO)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:KENDALL
Last Name:WARD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2629 FOOTHILL BLVD # 305
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91214-3511
Mailing Address - Country:US
Mailing Address - Phone:310-948-3987
Mailing Address - Fax:
Practice Address - Street 1:2629 FOOTHILL BLVD # 305
Practice Address - Street 2:
Practice Address - City:LA CRESCENTA
Practice Address - State:CA
Practice Address - Zip Code:91214-3511
Practice Address - Country:US
Practice Address - Phone:818-806-8830
Practice Address - Fax:818-536-7695
Is Sole Proprietor?:No
Enumeration Date:2017-06-20
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA18553207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine