Individual
COLE KISSICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
18111 NORDHOFF ST, NORTHRIDGE, CA 91330-0001
(805) 373-1486
Mailing address
18111 NORDHOFF ST, NORTHRIDGE, CA 91330-0001
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2000036671
CA
Other
Enumeration date
09/22/2017
Last updated
07/25/2019
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