Provider Demographics
NPI:1063042968
Name:NUGENT, CODY JAMES (PSYCHIATRIC NP DNP)
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:JAMES
Last Name:NUGENT
Suffix:
Gender:M
Credentials:PSYCHIATRIC NP DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8841 SPECTRUM CENTER BLVD APT 5306
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1468
Mailing Address - Country:US
Mailing Address - Phone:909-993-3168
Mailing Address - Fax:
Practice Address - Street 1:709 3RD AVE
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-5803
Practice Address - Country:US
Practice Address - Phone:619-585-3000
Practice Address - Fax:619-585-3002
Is Sole Proprietor?:No
Enumeration Date:2020-01-20
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95022492363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health