Healthcare Provider Details

I. General information

NPI: 1255792677
Provider Name (Legal Business Name): NICOLE CRISTINE MAURICIO CUADRO PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NICOLE CRISTINE MAURICIO AMARO MA

II. Dates (important events)

Enumeration Date: 03/12/2016
Last Update Date: 08/12/2022
Certification Date: 08/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVY MEDICAL READINESS & TRAINING COMMAND 1145 STURGIS ROAD
TWENTYNINE PALMS CA
92278-1513
US

IV. Provider business mailing address

64 PANORAMA DR
SAN FRANCISCO CA
94131-1244
US

V. Phone/Fax

Practice location:
  • Phone: 760-830-2117
  • Fax:
Mailing address:
  • Phone: 415-757-8306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: