Healthcare Provider Details

I. General information

NPI: 1316313190
Provider Name (Legal Business Name): MARIA NOLASCO N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2015
Last Update Date: 08/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15109 VANOWEN STREET
VAN NUYS CA
91409
US

IV. Provider business mailing address

10523 CROCKETT ST
SUN VALLEY CA
91352-4121
US

V. Phone/Fax

Practice location:
  • Phone: 818-902-5763
  • Fax: 818-904-3774
Mailing address:
  • Phone: 818-823-5933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95002632
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: