Provider Demographics
NPI:1548662992
Name:MATTHEW J NYKIEL MD, INC
Entity type:Organization
Organization Name:MATTHEW J NYKIEL MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:NYKIEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-291-4900
Mailing Address - Street 1:1113 ALTA AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-2803
Mailing Address - Country:US
Mailing Address - Phone:949-429-0890
Mailing Address - Fax:949-340-0696
Practice Address - Street 1:1113 ALTA AVE STE 103
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-2803
Practice Address - Country:US
Practice Address - Phone:949-429-0890
Practice Address - Fax:949-340-0696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-17
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1202562086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty