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General NPI Number Information
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NPI Number | 1427774009
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Entity Type | Individual
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Provider Name | MIRIAM-NIRVANA NAGOULAT NP
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Gender | Female
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Dates
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Enumeration Date | 10/17/2022
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Last Update Date | 02/12/2026
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Provider Practice Location Address
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Address Line | 7392 MAGNOLIA AVE
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City | RIVERSIDE
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State | CA
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Zip | 92504-3861
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Country | US
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Telephone | 951-352-3330
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Fax |
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Provider Business Mailing Address
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Address Line | 3114 BELVEDERE AVE
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City | HIGHLAND
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State | CA
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Zip | 92346-1614
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Country | US
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Telephone | 909-446-5965
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 95015160
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License Number State | CA
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