Provider Demographics
NPI:1053834838
Name:DOWNER, NATHANIEL (MT)
Entity type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:
Last Name:DOWNER
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3762 NAPA WAY
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93550-7945
Mailing Address - Country:US
Mailing Address - Phone:661-341-0314
Mailing Address - Fax:
Practice Address - Street 1:44830 VALLEY CENTRAL WAY STE 106
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93536-1505
Practice Address - Country:US
Practice Address - Phone:661-942-0252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-24
Last Update Date:2017-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA73101225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist