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General NPI Number Information
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NPI Number | 1346390911
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Entity Type | Individual
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Provider Name | NICOLE MULLINS M.P.T.
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Gender | Female
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 10/10/2017
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Provider Practice Location Address
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Address Line | 2831 CAMINO DEL RIO S STE 111
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City | SAN DIEGO
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State | CA
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Zip | 92108-3827
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Country | US
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Telephone | 619-340-0400
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Fax | 619-340-0407
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Provider Business Mailing Address
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Address Line | 7907 FORRESTAL RD
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City | SAN DIEGO
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State | CA
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Zip | 92120-1711
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Country | US
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Telephone | 619-847-8774
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Fax | 619-692-4148
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 21308
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License Number State | CA
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