Provider Demographics
NPI:1881106474
Name:SCHULTZ, NICOLE ISABELLA
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:ISABELLA
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5021 BELLA COLLINA ST
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-1924
Mailing Address - Country:US
Mailing Address - Phone:619-519-0759
Mailing Address - Fax:
Practice Address - Street 1:425 W BEECH ST UNIT 1458
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-8437
Practice Address - Country:US
Practice Address - Phone:909-910-1668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-03
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD3318041106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst