Healthcare Provider Details

I. General information

NPI: 1790051365
Provider Name (Legal Business Name): PASCUAL NOLASCO JR. MSAOM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2012
Last Update Date: 03/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 E LIVE OAK AVE STE 200
ARCADIA CA
91006-5272
US

IV. Provider business mailing address

1325 W GARVEY AVE N
WEST COVINA CA
91790-2242
US

V. Phone/Fax

Practice location:
  • Phone: 626-446-1221
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: