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General NPI Number Information
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NPI Number | 1609942846
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Entity Type | Individual
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Provider Name | NIKOLE N NASSEN PH.D.
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Gender | Female
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 01/14/2010
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Provider Practice Location Address
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Address Line | 614 5TH AVE STE A
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City | SAN DIEGO
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State | CA
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Zip | 92101-6964
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Country | US
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Telephone | 619-231-2668
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Fax |
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Provider Business Mailing Address
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Address Line | 3919 4TH AVE STE B
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City | SAN DIEGO
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State | CA
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Zip | 92103-3172
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Country | US
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Telephone | 619-231-2668
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Fax |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY23212
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License Number State | CA
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