Provider Demographics
NPI:1962696039
Name:HUDSPETH, NINA CHRISTINE (PSYD)
Entity type:Individual
Prefix:
First Name:NINA
Middle Name:CHRISTINE
Last Name:HUDSPETH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:923 S CATALINA AVE
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-4718
Mailing Address - Country:US
Mailing Address - Phone:310-792-5454
Mailing Address - Fax:310-792-5463
Practice Address - Street 1:10750 4TH ST STE 150
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-0979
Practice Address - Country:US
Practice Address - Phone:909-276-8320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-31
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY24904103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist