Nicholas Constantine Petikas, PH.D., ABPP

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

021404-01 Issued in NY

Practice address

Naval Medical Center San Diego
34800 Bob Wilson Dr
San Diego, CA 92134-0001

Phone

(619) 453-6591

NPI assigned

Sep 9, 2013

Sex

Male

Sole proprietor

No

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 30, 2022.

{
    "created_epoch": "1378684800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656547200000",
    "number": "1184059263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1335 HOLLY AVE.",
            "address_2": "UNIT 2",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "91932",
            "telephone_number": "516-369-3092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "NAVAL MEDICAL CENTER SAN DIEGO",
            "address_2": "34800 BOB WILSON DR",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921340001",
            "telephone_number": "619-453-6591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETIKAS",
        "first_name": "NICHOLAS",
        "middle_name": "CONSTANTINE",
        "name_prefix": "Dr.",
        "credential": "PH.D., ABPP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-09-09",
        "last_updated": "2022-06-30",
        "certification_date": "2022-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "021404-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Todd Bailey Peterson, M.D.
• Wendy Jo Peterson, R.D.
• William Charles Peterson, PA-C
• Amber Petersons, NMD
• James Pethers
• Anneliese Petitt
• Angela Petkofsky
• Patrick Petprasert
• Brent A Petre, DPT
• Yasmin Petree, PSYD.

• All providers in San Diego, CA
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.