Healthcare Provider Details

I. General information

NPI: 1962124552
Provider Name (Legal Business Name): NANCY BERNADETTE ST. JAMES PSY ASSOCIATE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2022
Last Update Date: 09/12/2022
Certification Date: 09/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2790 SKYPARK DR STE 205
TORRANCE CA
90505-5345
US

IV. Provider business mailing address

2790 SKYPARK DR STE 205
TORRANCE CA
90505-5345
US

V. Phone/Fax

Practice location:
  • Phone: 844-772-7792
  • Fax:
Mailing address:
  • Phone: 310-855-3990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberPSB94026940
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: