Provider Demographics
NPI:1053778126
Name:INGUILLO, NICHOLAS JOHN-CARLOS
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:JOHN-CARLOS
Last Name:INGUILLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2891 NICHOLAS DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-1537
Mailing Address - Country:US
Mailing Address - Phone:408-710-6575
Mailing Address - Fax:
Practice Address - Street 1:2891 NICHOLAS DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-1537
Practice Address - Country:US
Practice Address - Phone:408-710-6575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-20
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor