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NPI Code Detail

MEDICARE: PRINCESS MARIE APRIL TAGLE DENOLO NP

MEDICARE: PRINCESS MARIE APRIL TAGLE DENOLO NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerNP95018320CA

General Provider Information

NPI Number : 1447913603
Entity Type Code : Individual
Provider Name (Legal Business Name) : PRINCESS MARIE APRIL TAGLE DENOLO NP
Provider Business Mailing Address
First Line : 1450 S JELLICK AVE
Second Line : APT B
City : ROWLAND HTS
State : CA
Zip : 91748
Country : US
Telephone Number : 626-409-7703
Fax Number :
Provider Business Practice Location Address
First Line : 5885 BROCKTON AVE
Second Line :
City : RIVERSIDE
State : CA
Zip : 92506-1863
Country : US
Telephone Number : 800-270-5016
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/14/2021
Last Update Date : 10/14/2021

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