Provider Demographics
NPI:1336626035
Name:PFINGST, NICOLE (LAC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:PFINGST
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:641 MCCLAY RD
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94947-3861
Mailing Address - Country:US
Mailing Address - Phone:949-412-4417
Mailing Address - Fax:
Practice Address - Street 1:4666 CASS ST STE A
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-2860
Practice Address - Country:US
Practice Address - Phone:619-761-9544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-25
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17947171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist