Provider Demographics
NPI:1538379474
Name:NARDONE, NICHOLAS ANTHONY (DR AD, FACT, RAS)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:ANTHONY
Last Name:NARDONE
Suffix:
Gender:M
Credentials:DR AD, FACT, RAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9213 IROQUOIS WAY
Mailing Address - Street 2:
Mailing Address - City:WELDON
Mailing Address - State:CA
Mailing Address - Zip Code:93283-9722
Mailing Address - Country:US
Mailing Address - Phone:760-514-6883
Mailing Address - Fax:661-215-5884
Practice Address - Street 1:2731 NUGGET AVE
Practice Address - Street 2:
Practice Address - City:LAKE ISABELLA
Practice Address - State:CA
Practice Address - Zip Code:93240-9456
Practice Address - Country:US
Practice Address - Phone:760-379-3412
Practice Address - Fax:760-379-5332
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARI-NO 702250547101YA0400X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)