Healthcare Provider Details

I. General information

NPI: 1316308638
Provider Name (Legal Business Name): NICKIAH SIMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2016
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 BAKER ST
COSTA MESA CA
92626-4566
US

IV. Provider business mailing address

275 BAKER ST
COSTA MESA CA
92626-4566
US

V. Phone/Fax

Practice location:
  • Phone: 714-673-7095
  • Fax:
Mailing address:
  • Phone: 714-361-6768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-XCNVTD
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: