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General NPI Number Information
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NPI Number | 1194212787
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Entity Type | Individual
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Provider Name | NOLAN ALMODOVAR RBT
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Gender | Male
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Dates
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Enumeration Date | 04/18/2018
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Last Update Date | 04/18/2018
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Provider Practice Location Address
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Address Line | 18075 VENTURA BLVD STE 210
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City | ENCINO
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State | CA
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Zip | 91316-3596
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Country | US
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Telephone | 818-789-4540
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Fax | 800-516-1658
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Provider Business Mailing Address
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Address Line | 1407 FOOTHILL BLVD # 78
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City | LA VERNE
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State | CA
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Zip | 91750-3451
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Country | US
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Telephone | 818-789-4540
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Fax | 800-516-1658
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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