Healthcare Provider Details

I. General information

NPI: 1992464051
Provider Name (Legal Business Name): NICOLE VACCHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2021
Last Update Date: 11/01/2023
Certification Date: 11/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 W LAMBERT RD STE 101
BREA CA
92821-3940
US

IV. Provider business mailing address

2542 CLARKE AVE
FULLERTON CA
92831-4434
US

V. Phone/Fax

Practice location:
  • Phone: 626-656-3638
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number142103
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: