Healthcare Provider Details

I. General information

NPI: 1376301275
Provider Name (Legal Business Name): NICOLE MARIE SANTOS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2024
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9984 SCRIPPS RANCH BLVD UNIT 960
SAN DIEGO CA
92131-1825
US

IV. Provider business mailing address

8899 UNIVERSITY CENTER LN STE 240
SAN DIEGO CA
92122-1039
US

V. Phone/Fax

Practice location:
  • Phone: 619-880-6603
  • Fax:
Mailing address:
  • Phone: 858-249-4070
  • Fax: 858-249-4071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1000855
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95035252
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95035252
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1685358
License Number StateCO
# 5
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95292032
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: