Provider Demographics
NPI:1609013556
Name:NOLEN, TRACEY JOSEFA
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:JOSEFA
Last Name:NOLEN
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 1:649 E ALBERTONI ST
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-1538
Mailing Address - Country:US
Mailing Address - Phone:310-279-0851
Mailing Address - Fax:
Practice Address - Street 1:649 E ALBERTONI ST
Practice Address - Street 2:SUITE 100
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-1538
Practice Address - Country:US
Practice Address - Phone:310-279-0851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-14
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner