| Bambi L Nickelberry Md Professional Corporation | |
|
248 N Locust St Inglewood CA 90301-1258 | |
| (310) 673-3737 | |
| (310) 673-0248 |
| Full Name | Bambi L Nickelberry Md Professional Corporation |
|---|---|
| Speciality | Family Medicine |
| Location | 248 N Locust St, Inglewood, California |
| Authorized Official Name and Position | Bambi Lynn Nickelberry (DIRECTOR/OWNER) |
| Authorized Official Contact | 3106733737 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bambi L Nickelberry Md Professional Corporation 248 N Locust St Inglewood CA 90301-1258 Ph: (310) 673-3737 | Bambi L Nickelberry Md Professional Corporation 248 N Locust St Inglewood CA 90301-1258 Ph: (310) 673-3737 |
| NPI Number | 1972772655 |
|---|---|
| Provider Enumeration Date | 02/26/2008 |
| Last Update Date | 06/21/2022 |
| Medicare PECOS PAC ID | 3375920242 |
|---|---|
| Medicare Enrollment ID | O20220513002152 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972772655 | NPI | - | NPPES |
| 00G466791 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QA0505X | Family Medicine - Adult Medicine | G466791 (California) | Primary |
| Provider Name | Bambi Lynn Nickelberry |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1942383740 PECOS PAC ID: 3476553140 Enrollment ID: I20070102000407 |
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