Provider Demographics
NPI:1528182862
Name:MCINTOSH, NICHOLAS (REHAB STAFF)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:MCINTOSH
Suffix:
Gender:M
Credentials:REHAB STAFF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2221 CAMINO DEL RIO S
Mailing Address - Street 2:SUITE 305
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3608
Mailing Address - Country:US
Mailing Address - Phone:619-297-8111
Mailing Address - Fax:
Practice Address - Street 1:2221 CAMINO DEL RIO S
Practice Address - Street 2:SUITE 305
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3608
Practice Address - Country:US
Practice Address - Phone:619-297-8111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA10179Medicare UPIN