Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY26532 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY26532 | CA |
NPI | 1003196403 |
---|---|
Provider Name | Nicole Takla |
First Address | Pleasanton, CA 94566-7705 |
Second Address | Stockton, CA 95215-8312 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2011 |
Last Update Date | 30/09/2014 |