Healthcare Provider Details

I. General information

NPI: 1194050013
Provider Name (Legal Business Name): ANTOINETTE ESTHER NOLASCO B.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2009
Last Update Date: 09/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 E FOOTHILL BLVD
RIALTO CA
92376-5230
US

IV. Provider business mailing address

1950 S SUNWEST LN SUITE 200
SAN BERNARDINO CA
92415-2773
US

V. Phone/Fax

Practice location:
  • Phone: 909-421-9425
  • Fax: 909-421-9392
Mailing address:
  • Phone: 909-252-4017
  • Fax: 909-252-4055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: