Healthcare Provider Details

I. General information

NPI: 1063216992
Provider Name (Legal Business Name): ANNIKA FOX
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2025
Last Update Date: 01/14/2026
Certification Date: 01/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4451 30TH ST
SAN DIEGO CA
92116-4232
US

IV. Provider business mailing address

4451 30TH ST
SAN DIEGO CA
92116-4232
US

V. Phone/Fax

Practice location:
  • Phone: 619-483-0785
  • Fax:
Mailing address:
  • Phone: 619-483-0785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number21507
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: