Provider Demographics
NPI:1144266107
Name:NIX, SANDRA (MA)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:
Last Name:NIX
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26468 PASEO DEL MAR
Mailing Address - Street 2:#H
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-5112
Mailing Address - Country:US
Mailing Address - Phone:949-388-8639
Mailing Address - Fax:949-496-4736
Practice Address - Street 1:32118 PASEO ADELANTO
Practice Address - Street 2:SUITE 10
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-3627
Practice Address - Country:US
Practice Address - Phone:949-496-6074
Practice Address - Fax:949-496-4736
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT27399106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist