Individual ProviderNicholas Dibble-CiudadBehavior TechnicianBehavioral Health & Social Service ProvidersPractice Address4839 Vir Mar St Apt 9, Fair Oaks, CA 95628-8002(916) 868-7264PECOS EnrollmentBased on the most recent information from CMS, provider Nicholas Dibble-Ciudad does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1972013027Provider TypeIndividualFull NameDibble-Ciudad, NicholasGenderMaleSole ProprietorNoEnumeration Date10/3/2017Last Updated10/3/2017Contact InformationPractice LocationPractice Address4839 Vir Mar St Apt 9, Fair Oaks, CA 95628-8002Phone(916) 868-7264FaxUnlisted FaxMailing LocationMailing Address4839 Vir Mar St Apt 9, Fair Oaks, CA 95628-8002Phone(916) 868-7264FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode106S00000XPrimaryDescriptionBehavior TechnicianBehavioral Health & Social Service ProvidersLicenseUnlisted Issuer