Provider Demographics
NPI:1467442947
Name:NEVINS, VICKI (PHD)
Entity Type:Individual
Prefix:DR
First Name:VICKI
Middle Name:
Last Name:NEVINS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1337 CAMINO DEL MAR
Mailing Address - Street 2:STE C
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-2504
Mailing Address - Country:US
Mailing Address - Phone:858-271-1000
Mailing Address - Fax:
Practice Address - Street 1:1337 CAMINO DEL MAR
Practice Address - Street 2:STE C
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-2504
Practice Address - Country:US
Practice Address - Phone:858-271-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8293103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP8293Medicare ID - Type UnspecifiedMEDICARE