Healthcare Provider Details

I. General information

NPI: 1275908139
Provider Name (Legal Business Name): MS. NICOLE ANN HOEM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2015
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 WESTMOOR AVE
DALY CITY CA
94015-3843
US

IV. Provider business mailing address

123 EDGEMONT DR BLDG A
DALY CITY CA
94015-3868
US

V. Phone/Fax

Practice location:
  • Phone: 650-550-7400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: