Healthcare Provider Details

I. General information

NPI: 1457895476
Provider Name (Legal Business Name): NICOLE MICHELLE VACCARELLO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2016
Last Update Date: 05/23/2025
Certification Date: 05/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 E LIME AVE STE 102
MONROVIA CA
91016-2983
US

IV. Provider business mailing address

513 E LIME AVE STE 102
MONROVIA CA
91016-2983
US

V. Phone/Fax

Practice location:
  • Phone: 888-499-9303
  • Fax: 626-214-3868
Mailing address:
  • Phone: 888-499-9303
  • Fax: 626-214-3868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95005677
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: