Basic Information
| Provider Information | |||||||||
| NPI: | 1952930166 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CASCELLI | ||||||||
| FirstName: | NICHOLAS | ||||||||
| MiddleName: | GIOVANNI | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MS, ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11502 POEMA PL UNIT 102 | ||||||||
| Address2: | |||||||||
| City: | CHATSWORTH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913111110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8184395608 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 15031 RINALDI ST | ||||||||
| Address2: | |||||||||
| City: | MISSION HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913451207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183658051 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2020 | ||||||||
| LastUpdateDate: | 04/08/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | 2000029839 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.