Provider Demographics
NPI:1013915628
Name:NICOLINI, JOSEPH REESE (DO, PHD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:REESE
Last Name:NICOLINI
Suffix:
Gender:M
Credentials:DO, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 W BROADWAY
Mailing Address - Street 2:FOURTH FLOOR
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-3542
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2500 EAST MAIN STREET
Practice Address - Street 2:CHRISTUS SPOHN HOSPITAL
Practice Address - City:ALICE
Practice Address - State:TX
Practice Address - Zip Code:78332
Practice Address - Country:US
Practice Address - Phone:361-661-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-005945103TC0700X
CA20A8934207P00000X
TXP6048207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical