Provider Demographics
NPI:1518094101
Name:NICHOLS, FELICITA MAGDALENA
Entity Type:Individual
Prefix:
First Name:FELICITA
Middle Name:MAGDALENA
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6327 COTTLE RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-5632
Mailing Address - Country:US
Mailing Address - Phone:408-281-0311
Mailing Address - Fax:408-280-0144
Practice Address - Street 1:6327 COTTLE RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-5632
Practice Address - Country:US
Practice Address - Phone:408-281-0311
Practice Address - Fax:408-280-0144
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health