Basic Information
| Provider Information | |||||||||
| NPI: | 1336534627 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NIRVA | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | ANN | ||||||||
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| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HARRIS | ||||||||
| OtherFirstName: | NICOLE | ||||||||
| OtherMiddleName: | ANN | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 7933 FALL CREEK RD. | ||||||||
| Address2: | APT. 205 | ||||||||
| City: | DUBLIN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94568 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3135397501 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5729 SONOMA DR | ||||||||
| Address2: | SUITE F | ||||||||
| City: | PLEASANTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945667782 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9254622281 | ||||||||
| FaxNumber: | 9254620439 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2015 | ||||||||
| LastUpdateDate: | 04/02/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.