Kelly Marie Nicholas-Borboa

Primary specialty

Licensed Vocational NurseTaxonomy code 164X00000X

License

693512 Issued in CA

Practice address

490 N Grape St
Escondido, CA 92025-3079

Phone

(760) 975-9939

NPI assigned

Mar 23, 2018

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Kelly Dixon Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Community Research Foundation Inc

  • Community/Behavioral Health Agency
  • San Diego, CA
  • NPI 1952328700
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1521763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679443200000",
    "number": "1386148229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "280 W OLD JULIAN HWY",
            "city": "RAMONA",
            "state": "CA",
            "postal_code": "920652930",
            "telephone_number": "858-964-8744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "490 N GRAPE ST",
            "city": "ESCONDIDO",
            "state": "CA",
            "postal_code": "920253079",
            "telephone_number": "760-975-9939"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7488 Calzada De La Fuente",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921542717",
            "country_code": "US",
            "telephone_number": "619-661-5600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NICHOLAS-BORBOA",
        "first_name": "KELLY",
        "middle_name": "MARIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-23",
        "last_updated": "2023-03-22",
        "certification_date": "2023-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164X00000X",
            "taxonomy_group": "",
            "desc": "Licensed Vocational Nurse",
            "state": "CA",
            "license": "693512",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "DIXON",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Thai-Hanh Nguyen
• Tiffany Nguyen
• Xanh Nguyen, PHARMD
• NHS Pharma, Inc
• Evan Niakamal
• Carrie Beiner Nichols, MSW INTERN
• Courtney Rae Nidzieko
• Heidi Nielson, BA, ABAT, JDC
• Gissele Nieto
• Nightingale Esconidido Management Corp

• Licensed Vocational Nurse in Escondido, CA
• Providers in Escondido, CA by specialty
• Licensed Vocational Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2023; 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.