Provider Demographics
NPI:1336502582
Name:LABARDA, KRISOLITO MONES (FNP)
Entity Type:Individual
Prefix:
First Name:KRISOLITO
Middle Name:MONES
Last Name:LABARDA
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6299 FILLY CT
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-9590
Mailing Address - Country:US
Mailing Address - Phone:909-319-9911
Mailing Address - Fax:
Practice Address - Street 1:6299 FILLY CT
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91739-9590
Practice Address - Country:US
Practice Address - Phone:909-319-9911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-04
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95003981363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF0316485OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS CERTIFICATION
CA95003981OtherCALIFORNIA BOARD OF REGISTERED NURSING NURSE PRACTITIONER FURNISHING