Healthcare Provider Details

I. General information

NPI: 1013703057
Provider Name (Legal Business Name): NIKKI WARNER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2025
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3323 CARMEL MOUNTAIN RD STE 200
SAN DIEGO CA
92121-1035
US

IV. Provider business mailing address

3959 RUFFIN RD STE J
SAN DIEGO CA
92123-1830
US

V. Phone/Fax

Practice location:
  • Phone: 858-720-0991
  • Fax: 858-720-0992
Mailing address:
  • Phone: 858-279-5570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number81512
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: