Healthcare Provider Details

I. General information

NPI: 1538482401
Provider Name (Legal Business Name): JONATHAN NADLMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2010
Last Update Date: 03/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9107 WILSHIRE BLVD SUITE 215
BEVERLY HILLS CA
90210-5531
US

IV. Provider business mailing address

9107 WILSHIRE BLVD SUITE 215
BEVERLY HILLS CA
90210-5531
US

V. Phone/Fax

Practice location:
  • Phone: 310-364-4364
  • Fax:
Mailing address:
  • Phone: 310-364-4364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License NumberMFC 352
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: