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General NPI Number Information
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NPI Number | 1942949581
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Entity Type | Individual
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Provider Name | EVA NICOLAS PSYD
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Gender | Female
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Dates
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Enumeration Date | 06/01/2022
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Last Update Date | 06/14/2022
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Provider Practice Location Address
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Address Line | 431 MONTEREY AVE STE 7
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City | LOS GATOS
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State | CA
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Zip | 95030-5319
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Country | US
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Telephone | 415-205-3557
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Fax |
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Provider Business Mailing Address
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Address Line | 771 TALISMAN CT
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City | PALO ALTO
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State | CA
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Zip | 94303-4452
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Country | US
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Telephone |
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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 | PSY-005519
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 33412
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License Number State | CA
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