Most Relevant Information
Provider Data
| NPI Number: | 1003541806 |
| Provider Name: | NICOLE MACK |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 07/18/2022 |
| Last Updated: | 07/18/2022 |
Provider Practice Location
312 S JUNIPER ST STE 202
ESCONDIDO
CA
920254998
Practice Location Phone/Fax
| Phone: | 8884283223 |
| Fax: |
Provider Mailing Location
4221 WILSHIRE BLVD STE 300A
LOS ANGELES
CA
900103537
Provider Mailing Phone/Fax
| Phone: | 8884283223 |
| Fax: | 3238661881 |