MEDICARE: NICOLETTE NEFDT-GONZALEZ PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-08-4616	CA

General Provider Information

NPI Number	:	1275822959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLETTE NEFDT-GONZALEZ PH.D.

Provider Business Mailing Address
First Line	:	685 COCHRAN ST
Second Line	:	SUITE 220
City	:	SIMI VALLEY
State	:	CA
Zip	:	93065-1925
Country	:	US
Telephone Number	:	805-583-8060
Fax Number	:	805-583-8064

Provider Business Practice Location Address
First Line	:	685 COCHRAN ST
Second Line	:	SUITE 220
City	:	SIMI VALLEY
State	:	CA
Zip	:	93065-1925
Country	:	US
Telephone Number	:	805-583-8060
Fax Number	:	805-583-8064

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2011
Last Update Date	:	04/01/2011

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