Provider Demographics
NPI:1902065428
Name:NOGALES, MARIANA (NP)
Entity Type:Individual
Prefix:
First Name:MARIANA
Middle Name:
Last Name:NOGALES
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 1:1166 K ST
Mailing Address - Street 2:
Mailing Address - City:BRAWLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92227-2737
Mailing Address - Country:US
Mailing Address - Phone:760-344-9951
Mailing Address - Fax:
Practice Address - Street 1:233 WEST COLE ROAD
Practice Address - Street 2:
Practice Address - City:CALEXICO
Practice Address - State:CA
Practice Address - Zip Code:92231
Practice Address - Country:US
Practice Address - Phone:760-357-2020
Practice Address - Fax:760-357-1056
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP18128163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health