Healthcare Provider Details

I. General information

NPI: 1730020504
Provider Name (Legal Business Name): NICOLE GABRIELLA VENTURA OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3460 TORRANCE BLVD STE 100
TORRANCE CA
90503-5812
US

IV. Provider business mailing address

15239 LEMOLI AVE
GARDENA CA
90249-3925
US

V. Phone/Fax

Practice location:
  • Phone: 310-371-8555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number29029
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: