Provider Demographics
NPI:1316313190
Name:NOLASCO, MARIA (NP)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:NOLASCO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10523 CROCKETT ST
Mailing Address - Street 2:
Mailing Address - City:SUN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91352-4121
Mailing Address - Country:US
Mailing Address - Phone:818-823-5933
Mailing Address - Fax:
Practice Address - Street 1:15109 VANOWEN STREET
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91409
Practice Address - Country:US
Practice Address - Phone:818-902-5763
Practice Address - Fax:818-904-3774
Is Sole Proprietor?:No
Enumeration Date:2015-08-17
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95002632363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily