Provider Demographics
NPI:1538341243
Name:AGUIRRE, NICKOLAS PALACIO (NP)
Entity type:Individual
Prefix:
First Name:NICKOLAS
Middle Name:PALACIO
Last Name:AGUIRRE
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRAWLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92227-2630
Mailing Address - Country:US
Mailing Address - Phone:760-344-9951
Mailing Address - Fax:
Practice Address - Street 1:1166 K ST
Practice Address - Street 2:
Practice Address - City:BRAWLEY
Practice Address - State:CA
Practice Address - Zip Code:92227-2737
Practice Address - Country:US
Practice Address - Phone:760-344-9951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-04
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15896164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse