Provider Demographics
NPI:1851890966
Name:NOLBERTO, DEVONEY
Entity Type:Individual
Prefix:
First Name:DEVONEY
Middle Name:
Last Name:NOLBERTO
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 1:12424 MAPLEDALE ST
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-6026
Mailing Address - Country:US
Mailing Address - Phone:818-445-7618
Mailing Address - Fax:
Practice Address - Street 1:12424 MAPLEDALE ST
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-6026
Practice Address - Country:US
Practice Address - Phone:818-445-7618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-04
Last Update Date:2020-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95094994163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse