Healthcare Provider Details

I. General information

NPI: 1881200566
Provider Name (Legal Business Name): ALICIA RICKELS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2020
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 9TH AVE STE 208
SAN DIEGO CA
92101-7277
US

IV. Provider business mailing address

406 9TH AVE STE 208
SAN DIEGO CA
92101-7277
US

V. Phone/Fax

Practice location:
  • Phone: 619-554-8328
  • Fax: 619-780-7961
Mailing address:
  • Phone: 619-554-8328
  • Fax: 619-780-7961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number94028745
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: