Jack Lee Nicholson I
Jack Lee Nicholson I is an Attendant Care Provider in Lathrop, California. Practices as a sole proprietor. Licensed in California.
- Licensed in
- CA
- In the registry since
- 2019
- Specialties on file
- 2
Practice location Address checks out
460 Aztec LnLathrop, CA 95330-9142
Phone: (209) 451-8732
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Pin is approximate — placed at the ZIP-code centre, not the exact door.
Specialties & licences
| Attendant Care Provider (primary) | Taxonomy 3747A0650X (CA) |
|---|---|
| Attendant Care Provider | Taxonomy 3747A0650X |
Record details
| NPI number | 1831748318 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Male |
| Sole proprietor | Yes |
| NPI enumerated | September 8, 2019 |
| Last updated in NPPES | September 8, 2019 |