Healthcare Provider Details

I. General information

NPI: 1700355617
Provider Name (Legal Business Name): NICOLE H KRIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2018
Last Update Date: 07/21/2021
Certification Date: 07/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 N ASSOCIATED RD
BREA CA
92821-4338
US

IV. Provider business mailing address

7600 E. GRAVES AVE
ROSEMEAD CA
91770-3414
US

V. Phone/Fax

Practice location:
  • Phone: 310-339-7563
  • Fax:
Mailing address:
  • Phone: 626-280-6510
  • Fax: 626-288-8903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT108247
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT126397
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: