Healthcare Provider Details

I. General information

NPI: 1952680829
Provider Name (Legal Business Name): KAREN M MIKOLIC PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2011
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10620 TREENA ST STE 230
SAN DIEGO CA
92131-1140
US

IV. Provider business mailing address

PO BOX 2933
SUNNYVALE CA
94087-0933
US

V. Phone/Fax

Practice location:
  • Phone: 858-221-6311
  • Fax: 888-388-2142
Mailing address:
  • Phone: 858-221-6311
  • Fax: 888-388-2142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY1000723
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY8438
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: