Provider Demographics
NPI:1275991622
Name:NICODIM, FLORIN (COTA)
Entity Type:Individual
Prefix:
First Name:FLORIN
Middle Name:
Last Name:NICODIM
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2425 CANADA BLVD APT 204
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-1966
Mailing Address - Country:US
Mailing Address - Phone:818-484-8754
Mailing Address - Fax:818-484-8754
Practice Address - Street 1:16260 VENTURA BLVD STE 600
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-4604
Practice Address - Country:US
Practice Address - Phone:818-986-1977
Practice Address - Fax:818-986-4752
Is Sole Proprietor?:No
Enumeration Date:2016-01-31
Last Update Date:2016-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA398224Z00000X
CA4109225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant