Provider Demographics
NPI:1225205651
Name:DENICOLA, NATHANIEL GREGG (MD)
Entity type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:GREGG
Last Name:DENICOLA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18200 YORBA LINDA BLVD STE 111
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-4043
Mailing Address - Country:US
Mailing Address - Phone:714-646-8000
Mailing Address - Fax:714-572-2562
Practice Address - Street 1:18200 YORBA LINDA BLVD STE 102
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-4006
Practice Address - Country:US
Practice Address - Phone:714-577-6031
Practice Address - Fax:714-572-9538
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD443344207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1002836Medicaid