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General NPI Number Information
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NPI Number | 1376961102
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Entity Type | Individual
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Provider Name | NATHANIEL HEMEDES
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Gender | Male
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Dates
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Enumeration Date | 03/29/2014
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Last Update Date | 03/29/2014
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Provider Practice Location Address
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Address Line | 831 DELAWARE RD
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City | BURBANK
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State | CA
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Zip | 91504-3022
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Country | US
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Telephone | 818-232-4818
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Fax | 818-237-5473
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Provider Business Mailing Address
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Address Line | 831 DELAWARE RD
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City | BURBANK
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State | CA
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Zip | 91504-3022
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Country | US
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Telephone | 818-232-4818
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Fax | 818-237-5473
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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 | 376G00000X
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Taxonomy Name | Nursing Home Administrator
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License Number | 6005654740
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License Number State | CA
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