MEDICARE: MS. NISSI OKOLOSI

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	106S00000X	Behavior Technician		CA

General Provider Information

NPI Number	:	1386579274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NISSI OKOLOSI

Provider Business Mailing Address
First Line	:	3380 BLISS CT
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92503-5252
Country	:	US
Telephone Number	:	951-452-9266
Fax Number	:

Provider Business Practice Location Address
First Line	:	3380 BLISS CT
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92503-5252
Country	:	US
Telephone Number	:	951-452-9266
Fax Number	:

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

Provider Enumeration Date	:	06/15/2026
Last Update Date	:	06/15/2026

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Directions to “ MS. NISSI OKOLOSI ” Practice Location

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