JACQUELINE SAN NICOLAS
NPI 1225879273
Counselor - Mental Health in Los Angeles, CA
About Jacqueline San Nicolas NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
JACQUELINE SAN NICOLAS (NPI 1225879273) is an individual mental health provider in Los Angeles, California and active in the NPI registry since June 2024. She is enrolled in Medicare PECOS and is a graduate of Other (2019).
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Jacqueline San Nicolas is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Jacqueline San Nicolas reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Los Angeles, CA 90026
- Reassigned Medicare billing, California enrollment
- 21 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Jacqueline San Nicolas's NPI number?
The NPI number for Jacqueline San Nicolas is 1225879273. It was assigned to this individual provider in the NPPES registry on June 4, 2024.
Where is Jacqueline San Nicolas located?
Jacqueline San Nicolas practices at 1210 N Berendo St Apt 22, Los Angeles, CA 90029. The listed phone number is (626) 216-0788.
What is Jacqueline San Nicolas's specialty?
The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.
Is Jacqueline San Nicolas enrolled in Medicare?
Yes. Jacqueline San Nicolas is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Jacqueline San Nicolas's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Jacqueline San Nicolas reassigns Medicare benefits to Self Care Counseling Marriage Family And Child Therapy Inc. (Los Angeles, CA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Jacqueline San Nicolas's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Jacqueline San Nicolas was last updated on October 26, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Jacqueline San Nicolas · NPI 1225879273
Mental Health provider in Los Angeles, California. Individual provider, active in the CMS NPPES registry since June 4, 2024.
## Identity
- **NPI:** 1225879273 (Entity type: Individual)
- **Enumerated:** June 4, 2024
- **Primary specialty:** Counselor - Mental Health · taxonomy 101YM0800X
- **Sole proprietor:** Yes
## Practice location
- **Address:** 1210 N BERENDO ST APT 22, Los Angeles, CA 90029-1665
- **Phone:** (626) 216-0788
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment
- **Bills Medicare through:** Self Care Counseling Marriage Family And Child Therapy Inc. (NPI 1558909960, Los Angeles, CA), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2019
## Record status
- **NPPES last updated:** October 26, 2026
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Source: [NPI Profile](https://npiprofile.com/npi/1225879273) · Data from the CMS NPPES public registry.