Basic Information
| Provider Information | |||||||||
| NPI: | 1275991622 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | NICODIM | ||||||||
| FirstName: | FLORIN | ||||||||
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| Credential: | COTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2425 CANADA BLVD APT 204 | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 912081966 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8184848754 | ||||||||
| FaxNumber: | 8184848754 | ||||||||
| Practice Location | |||||||||
| Address1: | 16260 VENTURA BLVD STE 600 | ||||||||
| Address2: | |||||||||
| City: | ENCINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914364604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189861977 | ||||||||
| FaxNumber: | 8189864752 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2016 | ||||||||
| LastUpdateDate: | 01/31/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 398 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | 225200000X | 4109 | CA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.