Healthcare Provider Details

I. General information

NPI: 1306769807
Provider Name (Legal Business Name): KRISTIANA NIKOLOVA WEST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2026
Last Update Date: 08/01/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 MERCHANT ST
VACAVILLE CA
95688-6900
US

IV. Provider business mailing address

2114 BANNER CT
MARTINEZ CA
94553-5401
US

V. Phone/Fax

Practice location:
  • Phone: 707-446-8600
  • Fax:
Mailing address:
  • Phone: 925-348-7043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number164477
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: