Healthcare Provider Details

I. General information

NPI: 1467023416
Provider Name (Legal Business Name): NATHAN E NENADOV LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2021
Last Update Date: 07/09/2021
Certification Date: 07/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1689 N OSMUN AVE
CLOVIS CA
93619-7551
US

IV. Provider business mailing address

1689 N OSMUN AVE
CLOVIS CA
93619-7551
US

V. Phone/Fax

Practice location:
  • Phone: 559-473-6961
  • Fax:
Mailing address:
  • Phone: 559-473-6961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number21780
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: