Healthcare Provider Details

I. General information

NPI: 1285541086
Provider Name (Legal Business Name): NICHOLAS MARTIN
Entity Type: Individual
Gender:
Sole Proprietor: N

Provider Other Name: NICK MARTIN

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 S HIGHWAY 101 STE 1E
SOLANA BEACH CA
92075-2628
US

IV. Provider business mailing address

1345 ENCINITAS BLVD # 614
ENCINITAS CA
92024-2845
US

V. Phone/Fax

Practice location:
  • Phone: 858-314-8437
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW139279
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: