Healthcare Provider Details

I. General information

NPI: 1649734005
Provider Name (Legal Business Name): NICOLE BACHMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2019
Last Update Date: 01/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 GEORGIA ST STE 102
VALLEJO CA
94590-5962
US

IV. Provider business mailing address

1224 APPLE CREEK LN
SANTA ROSA CA
95401-7613
US

V. Phone/Fax

Practice location:
  • Phone: 888-544-5553
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: