Healthcare Provider Details

I. General information

NPI: 1346887841
Provider Name (Legal Business Name): NICHOLE L MARCHESE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2019
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 N 4TH ST STE 101
SAN JOSE CA
95112-5573
US

IV. Provider business mailing address

800 N 1ST ST
SAN JOSE CA
95112-6312
US

V. Phone/Fax

Practice location:
  • Phone: 669-245-3429
  • Fax: 408-550-7433
Mailing address:
  • Phone: 669-245-3429
  • Fax: 408-550-7433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: