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General NPI Number Information
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NPI Number | 1023837671
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Entity Type | Individual
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Provider Name | NATALIE ROSE NISPEROS DPT
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Gender | Female
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Dates
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Enumeration Date | 10/09/2024
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Last Update Date | 12/30/2024
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Provider Practice Location Address
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Address Line | 6041 CADILLAC AVE
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City | LOS ANGELES
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State | CA
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Zip | 90034-1702
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Country | US
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Telephone | 833-574-2273
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Fax |
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Provider Business Mailing Address
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Address Line | 5717 LAUREL CANYON BLVD APT 105
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City | VALLEY VILLAGE
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State | CA
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Zip | 91607-5202
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Country | US
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Telephone | 661-713-3692
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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