Provider Demographics
NPI:1275082422
Name:NOLASCO, GEOVANNY (CNIM 3529)
Entity Type:Individual
Prefix:
First Name:GEOVANNY
Middle Name:
Last Name:NOLASCO
Suffix:
Gender:M
Credentials:CNIM 3529
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6900 DALLAS PKWY
Mailing Address - Street 2:SUITE 800
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-7144
Mailing Address - Country:US
Mailing Address - Phone:214-396-7227
Mailing Address - Fax:
Practice Address - Street 1:6900 DALLAS PKWY
Practice Address - Street 2:SUITE 800
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-7144
Practice Address - Country:US
Practice Address - Phone:214-396-7227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-29
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3529246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic