Provider Demographics
NPI:1932632916
Name:MARISTELA, NICOLLETTE SISON
Entity Type:Individual
Prefix:
First Name:NICOLLETTE
Middle Name:SISON
Last Name:MARISTELA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 CLARINADA AVE
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-4212
Mailing Address - Country:US
Mailing Address - Phone:310-753-7644
Mailing Address - Fax:
Practice Address - Street 1:870 MARKET ST STE 928
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-2923
Practice Address - Country:US
Practice Address - Phone:415-508-7129
Practice Address - Fax:415-421-2928
Is Sole Proprietor?:No
Enumeration Date:2017-04-06
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA132826106H00000X
CA108467106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist