Provider Demographics
NPI:1528470895
Name:NICHOLS, CHRISTINA ELIZABETH (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:ELIZABETH
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CHRISTINA
Other - Middle Name:ELIZABETH
Other - Last Name:REPICKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2496 BAUER RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92145-0001
Mailing Address - Country:US
Mailing Address - Phone:858-307-9907
Mailing Address - Fax:
Practice Address - Street 1:2496 BAUER RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92145-0001
Practice Address - Country:US
Practice Address - Phone:858-307-9907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-21
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA01012587042084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD0000Medicare UPIN