Provider Demographics
NPI:1144582891
Name:O'MADDEN, NICHOLAS F
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:F
Last Name:O'MADDEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2377 GOLD MEADOW WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:GOLD RIVER
Mailing Address - State:CA
Mailing Address - Zip Code:95670-4444
Mailing Address - Country:US
Mailing Address - Phone:760-331-7553
Mailing Address - Fax:
Practice Address - Street 1:2377 GOLD MEADOW WAY STE 100
Practice Address - Street 2:
Practice Address - City:GOLD RIVER
Practice Address - State:CA
Practice Address - Zip Code:95670-4444
Practice Address - Country:US
Practice Address - Phone:916-631-1976
Practice Address - Fax:916-631-1975
Is Sole Proprietor?:No
Enumeration Date:2012-06-08
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3265101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health