Provider Demographics
NPI:1992259527
Name:EXCONDE, NATHALIE
Entity type:Individual
Prefix:MRS
First Name:NATHALIE
Middle Name:
Last Name:EXCONDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NATHALIE
Other - Middle Name:
Other - Last Name:SOLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 901961
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93590-1961
Mailing Address - Country:US
Mailing Address - Phone:661-264-7165
Mailing Address - Fax:
Practice Address - Street 1:1529 EAST PALMDALE BLVD SUITE 150
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550
Practice Address - Country:US
Practice Address - Phone:661-575-1800
Practice Address - Fax:661-265-6025
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-11
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA92645104100000X, 101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health