Healthcare Provider Details

I. General information

NPI: 1114709839
Provider Name (Legal Business Name): NICHOLAS ANDREW SALCEDO M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: NICK ANDREW SALCEDO M.S.

II. Dates (important events)

Enumeration Date: 10/17/2023
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5252 BALBOA AVE
SAN DIEGO CA
92117-6906
US

IV. Provider business mailing address

5252 BALBOA AVE
SAN DIEGO CA
92117-6906
US

V. Phone/Fax

Practice location:
  • Phone: 858-333-6856
  • Fax: 858-999-2014
Mailing address:
  • Phone: 858-333-6856
  • Fax: 858-999-2014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number14973
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number142420
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: