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NPI Code Detail

MEDICARE: NICHOLAS ANTHONY NARDONE DR. A.D., FACT, RAS

MEDICARE:   NICHOLAS ANTHONY NARDONE  DR. A.D., FACT, RAS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorRI-NO 702250547CA
2171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1538379474
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICHOLAS ANTHONY NARDONE DR. A.D., FACT, RAS
Provider Business Mailing Address
First Line : 9213 IROQUOIS WAY
Second Line :
City : WELDON
State : CA
Zip : 93283-9722
Country : US
Telephone Number : 760-514-6883
Fax Number : 661-215-5884
Provider Business Practice Location Address
First Line : 2731 NUGGET AVE
Second Line :
City : LAKE ISABELLA
State : CA
Zip : 93240-9456
Country : US
Telephone Number : 760-379-3412
Fax Number : 760-379-5332
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/22/2007
Last Update Date : 03/17/2018

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