Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Jacqueline San Nicolas

Individual provider Mental Health Counselor · NPI 1225879273

Jacqueline San Nicolas is a Mental Health Counselor in Los Angeles, California. Qualified in 2019, 7 years ago. Practices as a sole proprietor.

Years since qualifying
7
In the registry since
2024

Practice location Address checks out

3519 Eagle Rock Blvd
Los Angeles, CA 90065-2826
Phone: (323) 536-1640
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Mental Health Counselor (primary) Taxonomy 101YM0800X

Record details

NPI number1225879273
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedJune 4, 2024
Last updated in NPPESJune 4, 2024
Certification dateJune 4, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyMENTAL HEALTH COUNSELOR
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

Other providers in Los Angeles