Healthcare Provider Details

I. General information

NPI: 1568203206
Provider Name (Legal Business Name): NINA SINGH PHD
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2024
Last Update Date: 06/14/2024
Certification Date: 06/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3790 EL CAMINO REAL # 1258
PALO ALTO CA
94306-3314
US

IV. Provider business mailing address

3790 EL CAMINO REAL # 1258
PALO ALTO CA
94306-3314
US

V. Phone/Fax

Practice location:
  • Phone: 650-468-0585
  • Fax:
Mailing address:
  • Phone: 650-468-0585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number35067
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number35067
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number35067
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number35067
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: