Healthcare Provider Details

I. General information

NPI: 1265808315
Provider Name (Legal Business Name): MARIA NOLASCO NP A NURSING CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2015
Last Update Date: 08/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10523 CROCKETT ST
SUN VALLEY CA
91352-4121
US

IV. Provider business mailing address

10523 CROCKETT ST
SUN VALLEY CA
91352-4121
US

V. Phone/Fax

Practice location:
  • Phone: 818-823-5933
  • Fax:
Mailing address:
  • Phone: 818-823-5933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARIA ISABEL NOLASCO
Title or Position: NURSE PRACTITIONER
Credential: NP
Phone: 818-823-5933