Healthcare Provider Details

I. General information

NPI: 1710572276
Provider Name (Legal Business Name): NICOLE LEE HADLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2021
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2496 BAUER ROAD
SAN DIEGO CA
92145-0001
US

IV. Provider business mailing address

2496 BAUER ROAD
SAN DIEGO CA
92145-0001
US

V. Phone/Fax

Practice location:
  • Phone: 858-307-1011
  • Fax:
Mailing address:
  • Phone: 858-307-1011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101274418
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: