Provider Demographics
NPI:1841329299
Name:CAROVICH, NICHOLAS M (DPM)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:M
Last Name:CAROVICH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1503 N IMPERIAL AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-6301
Mailing Address - Country:US
Mailing Address - Phone:760-337-2800
Mailing Address - Fax:760-337-9099
Practice Address - Street 1:1503 N IMPERIAL AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-6301
Practice Address - Country:US
Practice Address - Phone:760-337-2800
Practice Address - Fax:760-337-9099
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-03
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3131213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGRE001481Medicaid
CAE3131Medicare ID - Type Unspecified
CA5913220001Medicare NSC
CA19276Medicare UPIN