Provider Demographics
NPI:1265005730
Name:PLASTIRAS, NICHOLAS COLEMAN
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:COLEMAN
Last Name:PLASTIRAS
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 1:33 MERWIN AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:CA
Mailing Address - Zip Code:94930-1644
Mailing Address - Country:US
Mailing Address - Phone:415-994-1106
Mailing Address - Fax:
Practice Address - Street 1:680 WILSON AVE
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94947-3825
Practice Address - Country:US
Practice Address - Phone:415-892-1643
Practice Address - Fax:415-892-5098
Is Sole Proprietor?:No
Enumeration Date:2021-07-21
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA131764106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist