Basic Information
| Provider Information | |||||||||
| NPI: | 1275109589 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NESS - NEVO SPORTS AND SPINE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3010 BEARD RD | ||||||||
| Address2: | |||||||||
| City: | NAPA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945583442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7072558825 | ||||||||
| FaxNumber: | 7072529325 | ||||||||
| Practice Location | |||||||||
| Address1: | 4849 VAN NUYS BLVD STE 202 | ||||||||
| Address2: | |||||||||
| City: | SHERMAN OAKS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914032110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188176377 | ||||||||
| FaxNumber: | 7473897005 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2021 | ||||||||
| LastUpdateDate: | 05/28/2021 | ||||||||
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| AuthorizedOfficialLastName: | NEVO | ||||||||
| AuthorizedOfficialFirstName: | ZEV | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8188176377 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
| NPICertificationDate: | 05/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.