Provider Demographics
NPI:1689213779
Name:ISCAKIS, NICHOLAS (RBT-18-62122)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:ISCAKIS
Suffix:
Gender:M
Credentials:RBT-18-62122
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 PASEO CAMARILLO STE 235
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-0754
Mailing Address - Country:US
Mailing Address - Phone:805-383-5566
Mailing Address - Fax:
Practice Address - Street 1:1000 PASEO CAMARILLO STE 235
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-0754
Practice Address - Country:US
Practice Address - Phone:805-383-5566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-06
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARBT-18-62122106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician