Provider Demographics
NPI:1700468311
Name:COLE, SIDNEY NICOLE GARDNER
Entity type:Individual
Prefix:MS
First Name:SIDNEY
Middle Name:NICOLE GARDNER
Last Name:COLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28955 PACIFIC COAST HWY # 200
Mailing Address - Street 2:
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-3953
Mailing Address - Country:US
Mailing Address - Phone:888-595-0235
Mailing Address - Fax:
Practice Address - Street 1:28955 PACIFIC COAST HWY # 200
Practice Address - Street 2:
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-3953
Practice Address - Country:US
Practice Address - Phone:888-595-0235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program