Healthcare Provider Details

I. General information

NPI: 1750127775
Provider Name (Legal Business Name): ALIYAH NANDI NICHOLS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2024
Last Update Date: 07/09/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3282 ADELINE ST
BERKELEY CA
94703-2439
US

IV. Provider business mailing address

3531 WALL AVE
RICHMOND CA
94804-3247
US

V. Phone/Fax

Practice location:
  • Phone: 510-981-5290
  • Fax:
Mailing address:
  • Phone: 510-375-5251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: