Active NPI
Nicole Fagundes, AMFT
- Marriage & Family Therapist
- Upland, CA
National Provider Identifier
1225698590
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 113888
- Practice address
- 1126 W Foothill Blvd
Upland, CA 91786-3768 - Phone
- (909) 985-0513
- NPI assigned
- Jun 18, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 113888 | CA | Primary |
Addresses
Primary practice location
1126 W Foothill Blvd
Upland, CA 91786-3768
Mailing address
1126 W Foothill Blvd
Upland, CA 91786-3768
Phone (909) 985-0513
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 113888 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1560816000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1620691200000",
"number": "1225698590",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1126 W FOOTHILL BLVD",
"city": "UPLAND",
"state": "CA",
"postal_code": "917863768",
"telephone_number": "909-985-0513"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1126 W FOOTHILL BLVD",
"city": "UPLAND",
"state": "CA",
"postal_code": "917863768",
"telephone_number": "909-985-0513"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAGUNDES",
"first_name": "NICOLE",
"credential": "AMFT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-06-18",
"last_updated": "2021-05-11",
"certification_date": "2021-05-11",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "113888",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Upland, CA
- Facenbody Surgery Center, Inc
- Faculty Physicians and Surgeons of Llusm
- Faculty Physicians and Surgeons of Llusm
- Faculty Physicians and Surgeons of Llusm
- Faculty Physicians and Surgeons of Llusm
- Hanieh Atef Fakhoury, MS
- Ryan Falcioni, PH.D.
- Families Choice Home Care Services, Inc.
- Family Planning Associates Medical Group Inc
- Family Planning Associates Medical Group Inc
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.