Healthcare Provider Details

I. General information

NPI: 1992826150
Provider Name (Legal Business Name): NICOLAS BRISENO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

339 PAJARO ST STE B
SALINAS CA
93901-3400
US

IV. Provider business mailing address

339 PAJARO ST STE B
SALINAS CA
93901-3400
US

V. Phone/Fax

Practice location:
  • Phone: 831-214-1724
  • Fax:
Mailing address:
  • Phone: 831-214-1724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: