Healthcare Provider Details

I. General information

NPI: 1700459641
Provider Name (Legal Business Name): NICOLE MARIE CONDE BRENES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2021
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6549 MISSION GORGE RD # 3018
SAN DIEGO CA
92120-2306
US

IV. Provider business mailing address

6549 MISSION GORGE RD # 3018
SAN DIEGO CA
92120-2306
US

V. Phone/Fax

Practice location:
  • Phone: 619-693-6346
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: