Provider Demographics
NPI:1629311980
Name:COLLINS, NANCY PALOMA (MS)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:PALOMA
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 32553
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90032-0553
Mailing Address - Country:US
Mailing Address - Phone:323-896-9794
Mailing Address - Fax:
Practice Address - Street 1:4701 VON KARMAN AVE STE 331
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-8150
Practice Address - Country:US
Practice Address - Phone:323-896-9794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA97352106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist