Healthcare Provider Details

I. General information

NPI: 1053249292
Provider Name (Legal Business Name): RAINIER NOFUENTE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2026
Last Update Date: 05/09/2026
Certification Date: 05/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 E 24TH ST
NATIONAL CITY CA
91950-6705
US

IV. Provider business mailing address

220 E 24TH ST
NATIONAL CITY CA
91950-6705
US

V. Phone/Fax

Practice location:
  • Phone: 619-474-6741
  • Fax:
Mailing address:
  • Phone: 619-474-6741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number10326
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: