| Doctor Name: | NICOLE TAKLA |
| NPI Number: | 1003196403 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PSYD |
| License Number: | PSY26532 |
| Business Practice Address: | 7707 Austin Rd Stockton, CA - 952158312 |
| Business Phone Number: | 2094674398 |
| Business Fax Number: | |
| Mailing Address: | 5424 Sunol Blvd, Suite 10-120 PLEASANTON |
| State: | CA |
| Postal Code: | 945667705 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 08/17/2011 |
| NPI Last Update Date: | 09/30/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | PSY26532 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |