Provider Demographics
NPI:1225651284
Name:HIMURO-FITZGERALD, NICOLE FUMIYE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:FUMIYE
Last Name:HIMURO-FITZGERALD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 JUNIPERO SERRA BLVD
Mailing Address - Street 2:STE 650
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94014-3891
Mailing Address - Country:US
Mailing Address - Phone:415-533-3501
Mailing Address - Fax:
Practice Address - Street 1:2235 MERCURY WAY STE 240
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95407-5443
Practice Address - Country:US
Practice Address - Phone:707-535-7212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-26
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist