Provider Demographics
NPI:1518295112
Name:NADELL, MICHAEL ROSS (CPO)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ROSS
Last Name:NADELL
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:7028 OWENSMOUTH AVE. 102
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-3195
Mailing Address - Country:US
Mailing Address - Phone:818-943-6105
Mailing Address - Fax:818-340-6910
Practice Address - Street 1:7028 OWENSMOUTH AVE. 102
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-3195
Practice Address - Country:US
Practice Address - Phone:818-943-6105
Practice Address - Fax:818-340-6910
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-20
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
1744P3200X
CA222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist