Provider Demographics
NPI:1194050013
Name:NOLASCO, ANTOINETTE ESTHER (BS)
Entity type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:ESTHER
Last Name:NOLASCO
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 S SUNWEST LN
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92415-2773
Mailing Address - Country:US
Mailing Address - Phone:909-252-4017
Mailing Address - Fax:909-252-4055
Practice Address - Street 1:850 E FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-5230
Practice Address - Country:US
Practice Address - Phone:909-421-9425
Practice Address - Fax:909-421-9392
Is Sole Proprietor?:No
Enumeration Date:2009-10-09
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program