Provider Demographics
NPI:1578939971
Name:TOMKIEWICZ, NINA
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:TOMKIEWICZ
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 1:3737 CAMINO DEL RIO S STE 302
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-4009
Mailing Address - Country:US
Mailing Address - Phone:619-787-6676
Mailing Address - Fax:619-243-3268
Practice Address - Street 1:3737 CAMINO DEL RIO S STE 302
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4009
Practice Address - Country:US
Practice Address - Phone:619-787-6676
Practice Address - Fax:619-243-3268
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-19
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program