=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740075530
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NINA B. PAUL, PHD - A PSYCHOLOGICAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/11/2025
-----------------------------------------------------
Last Update Date | 04/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11440 W BERNARDO CT STE 300
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92127-1644
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-897-1422
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 554 CLAYTON ST UNIT 170143
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94117-6203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-897-1422
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. NINA BIRGIT PAUL
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 650-897-1422
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------