Healthcare Provider Details

I. General information

NPI: 1386779544
Provider Name (Legal Business Name): MR. TODD ISRAEL NOSANOW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

373 SAINT CHARLES ST W
SAN ANDREAS CA
95249-7739
US

IV. Provider business mailing address

PO BOX 956
ANGELS CAMP CA
95222-0956
US

V. Phone/Fax

Practice location:
  • Phone: 209-754-6555
  • Fax:
Mailing address:
  • Phone: 209-747-8448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: