Healthcare Provider Details

I. General information

NPI: 1508921321
Provider Name (Legal Business Name): NICHOLAS HOYT ST. JOHN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 WELCH RD SUITE 212
PALO ALTO CA
94304-1507
US

IV. Provider business mailing address

750 WELCH RD SUITE 212
PALO ALTO CA
94304-1507
US

V. Phone/Fax

Practice location:
  • Phone: 650-724-2165
  • Fax: 650-724-6500
Mailing address:
  • Phone: 650-724-2165
  • Fax: 650-724-6500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY#19784
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: