Provider Demographics
NPI:1881356251
Name:NEVAREZ, NICOLAS ALEXANDER
Entity type:Individual
Prefix:
First Name:NICOLAS
Middle Name:ALEXANDER
Last Name:NEVAREZ
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 1:3043 CHARLOTTE AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-2501
Mailing Address - Country:US
Mailing Address - Phone:626-551-1704
Mailing Address - Fax:
Practice Address - Street 1:3043 CHARLOTTE AVE
Practice Address - Street 2:
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-2501
Practice Address - Country:US
Practice Address - Phone:626-551-1704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst