Healthcare Provider Details

I. General information

NPI: 1760074371
Provider Name (Legal Business Name): NICOLE MARIE KARST CAMLIN PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2021
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 FAY AVE STE 205
LA JOLLA CA
92037-4324
US

IV. Provider business mailing address

9911 SAGE HILL WAY
ESCONDIDO CA
92026-6604
US

V. Phone/Fax

Practice location:
  • Phone: 760-586-5832
  • Fax:
Mailing address:
  • Phone: 760-586-5832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPSY32340
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: