Nicole Lynn Ichull-Ingya, RADT

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

121090 Issued in CA

Practice address

2865 Logan Ave
San Diego, CA 92113-2411

Phone

(619) 232-4357

NPI assigned

Sep 23, 2020

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

• Nicole Lynn Iwan Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: telemed2u.nicoleichull@160918.advancedmd-direct.com

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 1689792533
  NPD (past)
• Community Research Foundation Inc

  • Community/Behavioral Health Agency
  • San Diego, CA
  • NPI 1952328700

  Clinical

  NPD (past)

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

{
    "created_epoch": "1600819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762646400000",
    "number": "1982210092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2865 LOGAN AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921132411",
            "telephone_number": "619-232-4357"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2865 LOGAN AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921132411",
            "telephone_number": "619-232-4357"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ICHULL-INGYA",
        "first_name": "NICOLE",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "RADT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-23",
        "last_updated": "2025-11-09",
        "certification_date": "2025-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "121090",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "IWAN",
            "middle_name": "LYNN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Icedown
• Jacob Ichimaru
• Michael Ichiyama, PH.D.
• Joshua Ichull Ingya
• Caleb Fanen Ichull-Ingya
• Ici 24 7 PC
• Cielito Cinco Ico, RN
• Idahosurgeons Net PC
• Xochitl Idarza Romero, RBT
• Jasmine Yhe Ide, M.D.

• Clinical Social Worker in San Diego, CA
• Providers in San Diego, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2025; 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.