Provider Demographics
NPI:1922417278
Name:AZEVEDO, NICOLE (MS, ATC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:AZEVEDO
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 S COLLEGE DR
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-6399
Mailing Address - Country:US
Mailing Address - Phone:805-922-6966
Mailing Address - Fax:805-349-8346
Practice Address - Street 1:800 S COLLEGE DR
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-6399
Practice Address - Country:US
Practice Address - Phone:805-922-6966
Practice Address - Fax:805-349-8346
Is Sole Proprietor?:No
Enumeration Date:2014-08-11
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer