Healthcare Provider Details

I. General information

NPI: 1639818305
Provider Name (Legal Business Name): ESTELLA NOLASCO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2022
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 W SHAW AVE STE 200
FRESNO CA
93704-2515
US

IV. Provider business mailing address

516 W SHAW AVE STE 200
FRESNO CA
93704-2515
US

V. Phone/Fax

Practice location:
  • Phone: 559-315-4304
  • Fax:
Mailing address:
  • Phone: 559-315-4304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number160480
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: