Healthcare Provider Details

I. General information

NPI: 1629595574
Provider Name (Legal Business Name): NIKKI CLEOPE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2017
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3235 UNION AVE
SAN JOSE CA
95124-2009
US

IV. Provider business mailing address

25342 ASPEN GLEN AVE
MORENO VALLEY CA
92551-2410
US

V. Phone/Fax

Practice location:
  • Phone: 408-371-0960
  • Fax:
Mailing address:
  • Phone: 951-332-1696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: