Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

St Nicholas Medical Group

Organization Geriatric Medicine (Internal Medicine) Physician · NPI 1891026100

St Nicholas Medical Group is a Geriatric Medicine (Internal Medicine) Physician in Los Angeles, California. Licensed in California. Registered with an NPI since 2010.

Licensed in
CA
In the registry since
2010

Practice location Address checks out

5520 Santa Monica Blvd Ste 112
Los Angeles, CA 90038-2932
Phone: (323) 860-9054
Fax: (323) 860-9053
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Geriatric Medicine (Internal Medicine) Physician (primary) Taxonomy 207RG0300X · Licence A60865 (CA)

Record details

NPI number1891026100
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Jacob Flores — Partner · (323) 860-9054
NPI enumeratedJanuary 26, 2010
Last updated in NPPESAugust 26, 2010
Mailing address5520 Santa Monica Blvd, Suite 112, Los Angeles, CA 90038-2932

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