Individual
JUSTIN ACE NILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
16500 VENTURA BLVD STE 414, ENCINO, CA 91436-5050
(818) 788-1003
Mailing address
16500 VENTURA BLVD STE 414, ENCINO, CA 91436-5050
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
106S00000X
CA
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
05/22/2023
Last updated
10/24/2024
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