Provider Demographics
NPI:1255442505
Name:KARAHALIOS, NICK J (MD)
Entity type:Individual
Prefix:
First Name:NICK
Middle Name:J
Last Name:KARAHALIOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:665 CAMINO DE LOS MARES STE 309
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-2841
Mailing Address - Country:US
Mailing Address - Phone:949-487-9034
Mailing Address - Fax:949-493-3721
Practice Address - Street 1:665 CAMINO DE LOS MARES STE 309
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-2841
Practice Address - Country:US
Practice Address - Phone:949-487-9034
Practice Address - Fax:949-493-3721
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG77834207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG02235Medicare UPIN
CAWG77834BMedicare PIN