Provider Demographics
NPI:1780751248
Name:KANEMARU-KLEIN, NIKKI (PHD)
Entity type:Individual
Prefix:DR
First Name:NIKKI
Middle Name:
Last Name:KANEMARU-KLEIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:NIKKI
Other - Middle Name:
Other - Last Name:KANEMARU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3505 CORTE ROMERO
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-8471
Mailing Address - Country:US
Mailing Address - Phone:858-350-4624
Mailing Address - Fax:
Practice Address - Street 1:3505 CORTE ROMERO
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-8471
Practice Address - Country:US
Practice Address - Phone:858-775-0816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22992103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical