Healthcare Provider Details

I. General information

NPI: 1033891767
Provider Name (Legal Business Name): NICHOLAS VENTURA OTR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2023
Last Update Date: 08/02/2023
Certification Date: 08/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8600 W 3RD ST STE 3B
LOS ANGELES CA
90048-3338
US

IV. Provider business mailing address

8600 W 3RD ST STE 3B
LOS ANGELES CA
90048-3338
US

V. Phone/Fax

Practice location:
  • Phone: 310-275-2130
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOT25247
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: