Provider Demographics
NPI:1699083881
Name:NASSAU, DANA NICOLE (CD(DONA))
Entity type:Individual
Prefix:MRS
First Name:DANA
Middle Name:NICOLE
Last Name:NASSAU
Suffix:
Gender:F
Credentials:CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4044 W 28TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90018-2216
Mailing Address - Country:US
Mailing Address - Phone:310-993-7238
Mailing Address - Fax:
Practice Address - Street 1:4044 W 28TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90018-2216
Practice Address - Country:US
Practice Address - Phone:310-993-7238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-22
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA150422106H00000X
374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No374J00000XNursing Service Related ProvidersDoula