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General NPI Number Information
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NPI Number | 1568812774
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Entity Type | Individual
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Provider Name | DOUGLAS NESTOROVSKI MD
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Gender | Male
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Dates
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Enumeration Date | 06/18/2016
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Last Update Date | 05/27/2022
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Provider Practice Location Address
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Address Line | 1520 SAN PABLO ST STE 2000
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City | LOS ANGELES
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State | CA
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Zip | 90033-5322
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Country | US
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Telephone | 248-794-3758
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Fax |
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Provider Business Mailing Address
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Address Line | 635 S HOBART BLVD APT 404
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City | LOS ANGELES
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State | CA
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Zip | 90005-5505
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Country | US
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Telephone | 248-794-3758
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 2016016969
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | A172070
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License Number State | CA
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