Healthcare Provider Details

I. General information

NPI: 1255295176
Provider Name (Legal Business Name): NICOLE GEIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3540 AERO CT
SAN DIEGO CA
92123-1711
US

IV. Provider business mailing address

11694 COMPASS POINT DR N APT 168
SAN DIEGO CA
92126-8581
US

V. Phone/Fax

Practice location:
  • Phone: 858-874-4338
  • Fax:
Mailing address:
  • Phone: 858-874-4338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number4EE2908D8F
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: