Basic Information
| Provider Information | |||||||||
| NPI: | 1942882725 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VIRTO | ||||||||
| FirstName: | NATHAN | ||||||||
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| Credential: | BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4880 MARKET ST | ||||||||
| Address2: | |||||||||
| City: | VENTURA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930037783 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056587827 | ||||||||
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| Practice Location | |||||||||
| Address1: | 15260 VENTURA BLVD STE 1140 | ||||||||
| Address2: | |||||||||
| City: | SHERMAN OAKS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914035346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189867827 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/22/2021 | ||||||||
| LastUpdateDate: | 04/22/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-2149243 | CA | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.