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NPI Code Detail

MEDICARE: CHRISTA NICHELL NETTLES

MEDICARE: CHRISTA NICHELL NETTLES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225400000XRehabilitation Practitioner
2225C00000XRehabilitation CounselorCA
3390200000XStudent in an Organized Health Care Education/Training Program
4103T00000XPsychologist

General Provider Information

NPI Number : 1609036516
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTA NICHELL NETTLES
Provider Business Mailing Address
First Line : 320 N MADISON AVE STE B
Second Line :
City : LOS ANGELES
State : CA
Zip : 90004-3791
Country : US
Telephone Number : 323-644-2040
Fax Number :
Provider Business Practice Location Address
First Line : 320 N MADISON AVE STE B
Second Line :
City : LOS ANGELES
State : CA
Zip : 90004-3791
Country : US
Telephone Number : 323-644-2040
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2008
Last Update Date : 06/16/2023

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1679228985 — ANTHONY BERRIOS
Practice Location Address:
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Practice Fax:
1235853722 — JIAYI YANG
Practice Location Address:
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1568200368 — CRYSTAL KELLEY
Practice Location Address:
320 N MADISON AVE STE B
LOS ANGELES, CA
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1558187351 — MS. RYEISHA SHAWNTAE MOORE-NASH
Practice Location Address:
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Directions to “ CHRISTA NICHELL NETTLES ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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