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NPI Code Detail

MEDICARE: DR. NICOLE LOUISE JENSEN PSY.D.

MEDICARE: DR. NICOLE LOUISE JENSEN PSY.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical PsychologistPSY18674CA
2103T00000XPsychologistPSY18674CA

General Provider Information

NPI Number : 1770551749
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NICOLE LOUISE JENSEN PSY.D.
Provider Business Mailing Address
First Line : 2731 RIDGELINE DR APT 305
Second Line :
City : CORONA
State : CA
Zip : 92882-8750
Country : US
Telephone Number : 714-235-0857
Fax Number :
Provider Business Practice Location Address
First Line : 14901 CENTRAL AVE
Second Line :
City : CHINO
State : CA
Zip : 91710-9500
Country : US
Telephone Number : 855-888-8515
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/08/2006
Last Update Date : 08/30/2024

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