Provider Demographics
NPI:1780700716
Name:TERRAZAS, NICHOLAS ANDREW
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:ANDREW
Last Name:TERRAZAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:542 N HOMEREST AVE
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91791-1232
Mailing Address - Country:US
Mailing Address - Phone:626-705-5302
Mailing Address - Fax:
Practice Address - Street 1:4740 N GRAND AVE
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91724-2005
Practice Address - Country:US
Practice Address - Phone:626-859-2089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor