Provider Demographics
NPI:1740708098
Name:PACIFICO, NICOLLE ANDREEA (PHD)
Entity type:Individual
Prefix:
First Name:NICOLLE
Middle Name:ANDREEA
Last Name:PACIFICO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:NICOLLE
Other - Middle Name:ANDREEA
Other - Last Name:BUGESCU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:4300 ROSE DR
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-2026
Mailing Address - Country:US
Mailing Address - Phone:714-528-4211
Mailing Address - Fax:
Practice Address - Street 1:4300 ROSE DR
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-2026
Practice Address - Country:US
Practice Address - Phone:714-528-4211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-07
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY29488103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty