Basic Information
| Provider Information | |||||||||
| NPI: | 1962696039 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HUDSPETH | ||||||||
| FirstName: | NINA | ||||||||
| MiddleName: | CHRISTINE | ||||||||
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| Credential: | PSYD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 923 S CATALINA AVE | ||||||||
| Address2: | |||||||||
| City: | REDONDO BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902774718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3107925454 | ||||||||
| FaxNumber: | 3107925463 | ||||||||
| Practice Location | |||||||||
| Address1: | 10750 4TH ST STE 150 | ||||||||
| Address2: | |||||||||
| City: | RANCHO CUCAMONGA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917300979 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9092768320 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2007 | ||||||||
| LastUpdateDate: | 09/29/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | PSY24904 | CA | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.