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General NPI Number Information
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NPI Number | 1811711039
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Entity Type | Individual
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Provider Name | RAE MICHAEL NOLAN
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Gender | Male
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Dates
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Enumeration Date | 11/13/2024
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Last Update Date | 06/07/2025
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Provider Practice Location Address
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Address Line | 650 S INDIAN HILL BLVD
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City | CLAREMONT
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State | CA
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Zip | 91711-5444
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Country | US
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Telephone | 909-398-2444
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Fax |
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Provider Business Mailing Address
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Address Line | 205 E 53RD ST
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City | SAN BERNARDINO
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State | CA
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Zip | 92404-1115
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Country | US
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Telephone | 562-661-3643
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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