Provider Demographics
NPI:1992190383
Name:NIKOLOVA, NATALIA (PHD)
Entity type:Individual
Prefix:
First Name:NATALIA
Middle Name:
Last Name:NIKOLOVA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13700 ALTON PKWY 154-145
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17744 SKY PARK CIR
Practice Address - Street 2:STE 285
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-4461
Practice Address - Country:US
Practice Address - Phone:310-800-1791
Practice Address - Fax:310-496-2952
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-01
Last Update Date:2018-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY26976103TF0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic