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

St Nicholas Medical Group

Organization Family Medicine Physician · NPI 1982808622

St Nicholas Medical Group is a Family Medicine Physician in Los Angeles, California. Licensed in California. Registered with an NPI since 2007.

Licensed in
CA
In the registry since
2007

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

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence A40329 (CA)

Record details

NPI number1982808622
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Lorenzo Tizon — Medical Director · (323) 860-9054
NPI enumeratedJune 14, 2007
Last updated in NPPESFebruary 8, 2010
Mailing address5520 Santa Monica Blvd, Suite 112, Los Angeles, CA 90038

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