MEDICARE: NICHOLE SEAN PEREZ PACUNO

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
1	163W00000X	Registered Nurse	95268346	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	F4753162	OTHER	CA	DRIVERS LICENSE

General Provider Information

NPI Number	:	1538801998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLE SEAN PEREZ PACUNO

Provider Business Mailing Address
First Line	:	3610 E POLLOCK ST UNIT 5
Second Line	:
City	:	ONTARIO
State	:	CA
Zip	:	91761-0662
Country	:	US
Telephone Number	:	347-813-5490
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 S TUSTIN ST
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92866-2550
Country	:	US
Telephone Number	:	714-289-3936
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2022
Last Update Date	:	12/08/2025

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