Provider Demographics
NPI:1356766638
Name:LOIS V NIGHTINGALE, PH.D. A PSYCHOLOGICAL CORPORATION
Entity type:Organization
Organization Name:LOIS V NIGHTINGALE, PH.D. A PSYCHOLOGICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LOIS
Authorized Official - Middle Name:
Authorized Official - Last Name:NIGHTINGALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-993-5343
Mailing Address - Street 1:16960 BASTANCHURY RD STE J
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-1711
Mailing Address - Country:US
Mailing Address - Phone:714-993-5343
Mailing Address - Fax:
Practice Address - Street 1:16960 BASTANCHURY RD STE J
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-1711
Practice Address - Country:US
Practice Address - Phone:714-993-5343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-24
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9503103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1982700852OtherTYPE I NPI
CA1982700852OtherTYPE I NPI
CACP9503Medicare PIN