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NPI Code Detail

MEDICARE: HEATHER NENOV OD

MEDICARE: HEATHER NENOV OD
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
1152W00000XOptometrist34386TLGCA

General Provider Information

NPI Number : 1427606508
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEATHER NENOV OD
Provider Business Mailing Address
First Line : 3200 N SEPULVEDA BLVD
Second Line : STE E4
City : MANHATTAN BEACH
State : CA
Zip : 90266-2469
Country : US
Telephone Number : 310-795-9636
Fax Number :
Provider Business Practice Location Address
First Line : 3200 N SEPULVEDA BLVD STE E4
Second Line :
City : MANHATTAN BEACH
State : CA
Zip : 90266-2469
Country : US
Telephone Number : 310-546-5568
Fax Number : 310-546-5421
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2019
Last Update Date : 10/11/2019

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Directions to “ HEATHER NENOV OD” Practice Location

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