Provider Demographics
NPI:1366518516
Name:NAWA, JOEY
Entity type:Individual
Prefix:
First Name:JOEY
Middle Name:
Last Name:NAWA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3710 ROBERTSON BLVD
Mailing Address - Street 2:STE 225
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-2350
Mailing Address - Country:US
Mailing Address - Phone:323-309-5945
Mailing Address - Fax:
Practice Address - Street 1:3710 ROBERTSON BLVD STE 225
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-2351
Practice Address - Country:US
Practice Address - Phone:323-309-5945
Practice Address - Fax:310-838-8454
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7404225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist