Provider Demographics
NPI:1225736648
Name:NOLASCO RAMIREZ, FABRICIO
Entity Type:Individual
Prefix:
First Name:FABRICIO
Middle Name:
Last Name:NOLASCO RAMIREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:933 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18510-1019
Mailing Address - Country:US
Mailing Address - Phone:347-338-7303
Mailing Address - Fax:
Practice Address - Street 1:933 MADISON AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-1019
Practice Address - Country:US
Practice Address - Phone:347-338-7303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program