Provider Demographics
NPI:1114899077
Name:PAGE, NICHOLAS JOHN
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:JOHN
Last Name:PAGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10717 CAMINO RUIZ
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-2360
Mailing Address - Country:US
Mailing Address - Phone:858-695-2211
Mailing Address - Fax:
Practice Address - Street 1:10717 CAMINO RUIZ
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-2360
Practice Address - Country:US
Practice Address - Phone:858-695-2211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-20
Last Update Date:2025-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program