Healthcare Provider Details

I. General information

NPI: 1861734428
Provider Name (Legal Business Name): TODD NATHAN NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2013
Last Update Date: 07/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 MARENGO ST.
LOS ANGELES CA
90033
US

IV. Provider business mailing address

1920 MARENGO ST.
LOS ANGELES CA
90033
US

V. Phone/Fax

Practice location:
  • Phone: 310-945-3350
  • Fax: 310-945-3350
Mailing address:
  • Phone: 310-945-3350
  • Fax: 310-945-3350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number16777
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number21812
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number21812
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: