Provider Demographics
NPI:1316225840
Name:PARDO-MCDONALD, NISEL
Entity Type:Individual
Prefix:
First Name:NISEL
Middle Name:
Last Name:PARDO-MCDONALD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41945 BIG BEAR BLVD
Mailing Address - Street 2:SUITE222
Mailing Address - City:BIG BEAR LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:92315
Mailing Address - Country:US
Mailing Address - Phone:909-866-5070
Mailing Address - Fax:909-878-3228
Practice Address - Street 1:41945 BIG BEAR BLVD
Practice Address - Street 2:SUITE222
Practice Address - City:BIG BEAR LAKE
Practice Address - State:CA
Practice Address - Zip Code:92315
Practice Address - Country:US
Practice Address - Phone:909-866-5070
Practice Address - Fax:909-878-3228
Is Sole Proprietor?:No
Enumeration Date:2011-08-02
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor