Individual
NIKOLAY NISIMOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
330 GOLDEN SHR, LONG BEACH, CA 90802-4246
(866) 985-5008
Mailing address
855 S WOOSTER ST, LOS ANGELES, CA 90035-1772
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
—
—
Other
Enumeration date
07/10/2013
Last updated
07/10/2013
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