Provider Demographics
NPI:1710044375
Name:NYAMORA, CORY MIKEL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CORY
Middle Name:MIKEL
Last Name:NYAMORA
Suffix:
Gender:M
Credentials:PSYD
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 215210
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-1210
Mailing Address - Country:US
Mailing Address - Phone:510-981-1471
Mailing Address - Fax:844-630-7783
Practice Address - Street 1:759 APPIAN WAY STE 2D
Practice Address - Street 2:
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564-2470
Practice Address - Country:US
Practice Address - Phone:510-981-1471
Practice Address - Fax:844-630-7783
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 20441103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical