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General NPI Number Information
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NPI Number | 1013339084
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Entity Type | Organization
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Legal Business Name | TAKESHIA C. NIDAY, M.D. A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 01/10/2014
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Last Update Date | 01/10/2014
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Provider Practice Location Address
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Address Line | 2760 FIFTH AVE SUITE 205
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City | SAN DIEGO
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State | CA
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Zip | 92103-6325
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Country | US
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Telephone | 619-500-6566
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Fax | 619-374-2982
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Provider Business Mailing Address
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Address Line | 2760 FIFTH AVE SUITE 205
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City | SAN DIEGO
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State | CA
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Zip | 92103-6325
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Country | US
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Telephone | 619-500-6566
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Fax | 619-374-2982
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Authorized Official
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Title or Position | PRESIDENT
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Name | TAKESHIA NIDAY
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Credential | M.D.
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Telephone | 619-500-6566
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | A113548
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number | A113548
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License Number State | CA
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