Healthcare Provider Details

I. General information

NPI: 1467442947
Provider Name (Legal Business Name): VICKI NEVINS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 03/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1337 CAMINO DEL MAR STE C
DEL MAR CA
92014-2504
US

IV. Provider business mailing address

1337 CAMINO DEL MAR STE C
DEL MAR CA
92014-2504
US

V. Phone/Fax

Practice location:
  • Phone: 858-271-1000
  • Fax:
Mailing address:
  • Phone: 858-271-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY8293
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: