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General NPI Number Information
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NPI Number | 1609013556
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Entity Type | Individual
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Provider Name | TRACEY JOSEFA NOLEN
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Gender | Female
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Dates
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Enumeration Date | 01/14/2009
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Last Update Date | 04/04/2018
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Provider Practice Location Address
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Address Line | 649 E ALBERTONI ST SUITE 100
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City | CARSON
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State | CA
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Zip | 90746-1538
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Country | US
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Telephone | 310-279-0851
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Fax |
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Provider Business Mailing Address
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Address Line | 649 E ALBERTONI ST
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City | CARSON
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State | CA
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Zip | 90746-1538
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Country | US
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Telephone | 310-279-0851
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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 | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State |
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