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NPI Code Detail

MEDICARE: DR. NICOLE MAYEDA PSY.D.

MEDICARE: DR. NICOLE MAYEDA PSY.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist26451CA

General Provider Information

NPI Number : 1619292729
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NICOLE MAYEDA PSY.D.
Provider Business Mailing Address
First Line : 3407 S CORBETT AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97239-4621
Country : US
Telephone Number : 415-735-0029
Fax Number :
Provider Business Practice Location Address
First Line : 3407 S CORBETT AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97239-4621
Country : US
Telephone Number : 415-735-0029
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/31/2010
Last Update Date : 05/18/2026

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