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JACQUELINE SAN NICOLAS
NPI 1225879273
Counselor - Mental Health in Los Angeles, CA

Active since June 04, 2024PECOS Enrolled
3519 EAGLE ROCK BLVD, LOS ANGELES, CA 90065(323) 536-1640 Get Directions Write a Review

NPPES record last updated: June 4, 2024. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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

NPI1225879273
Entity TypeIndividualFemale
Primary Taxonomy101YM0800X
Provider Legal NameJACQUELINE SAN NICOLAS
Location Address3519 EAGLE ROCK BLVDLos Angeles, CA 90065-2826
Mailing Address1210 N Berendo St Apt 22Los Angeles, CA 90029-1665 · (626) 216-0788
Phone(323) 536-1640
Sole ProprietorYes
Medical School CMSOtherGraduated 2019
Enumeration DateJune 4, 2024
NPPES CertifiedJune 4, 2024
✔ NPI 1225879273 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers
Taxonomy Code101YM0800X
3519 EAGLE ROCK BLVD, Los Angeles, CA 90065
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jacqueline San Nicolas is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID5799274445
PECOS Enrollment IDI20251031001930
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

GURUDARSHAN K DELORME LMFT
Marriage & Family Therapist
3519 EAGLE ROCK BLVD
LOS ANGELES, CA 90065
Los Angeles County (323) 646-0026
ANGELA MEDRANO
Social Worker (Clinical)
3519 EAGLE ROCK BLVD
LOS ANGELES, CA 90065
Los Angeles County (323) 536-1640
HEATHER ARNDT MFT INTERN
Marriage & Family Therapist
3519 EAGLE ROCK BLVD
LOS ANGELES, CA 90065
Los Angeles County (323) 405-4928
PARISA FROST
Marriage & Family Therapist
3519 EAGLE ROCK BLVD
LOS ANGELES, CA 90065
Los Angeles County (424) 333-2858
AMBER NICOLE SALIK
Marriage & Family Therapist
3519 EAGLE ROCK BLVD
LOS ANGELES, CA 90065
Los Angeles County (323) 536-1640

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 3519 Eagle Rock Blvd, Los Angeles, CA 90065. The listed phone number is (323) 536-1640.

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.

When was this NPI record last updated?

The NPPES record for Jacqueline San Nicolas was last updated on June 4, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years 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.