Provider Demographics
NPI:1194212787
Name:ALMODOVAR, NOLAN (RBT)
Entity Type:Individual
Prefix:
First Name:NOLAN
Middle Name:
Last Name:ALMODOVAR
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1407 FOOTHILL BLVD # 78
Mailing Address - Street 2:
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-3451
Mailing Address - Country:US
Mailing Address - Phone:818-789-4540
Mailing Address - Fax:800-516-1658
Practice Address - Street 1:18075 VENTURA BLVD STE 210
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-3596
Practice Address - Country:US
Practice Address - Phone:818-789-4540
Practice Address - Fax:800-516-1658
Is Sole Proprietor?:No
Enumeration Date:2018-04-18
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician