Provider Demographics
NPI:1174989818
Name:KUTZHANOVA, NAILYA
Entity type:Individual
Prefix:
First Name:NAILYA
Middle Name:
Last Name:KUTZHANOVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9033 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:PICO RIVERA
Mailing Address - State:CA
Mailing Address - Zip Code:90660-3839
Mailing Address - Country:US
Mailing Address - Phone:562-942-9625
Mailing Address - Fax:
Practice Address - Street 1:8081 HOLLAND DR APT G18
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-6393
Practice Address - Country:US
Practice Address - Phone:949-508-8038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-11
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
125938106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist