Most Relevant Information
Provider Data
| NPI Number: | 1003288481 |
| Provider Name: | NICHOLAS WALTHER PA-C |
| Entity Type: | Individual |
| Taxonomy Code: | 363AM0700X |
| Specialty: | Physician Assistant |
| License Number: | 52987 |
Most Important Dates
| Enumeration Date: | 10/26/2015 |
| Last Updated: | 10/26/2015 |
Provider Practice Location
2101 N WATERMAN AVE
SAN BERNARDINO
CA
924044836
Practice Location Phone/Fax
| Phone: | 9098838711 |
| Fax: |
Provider Mailing Location
2101 N WATERMAN AVE
SAN BERNARDINO
CA
924044836
Provider Mailing Phone/Fax
| Phone: | 9098838711 |
| Fax: |