Provider Demographics
NPI:1952676470
Name:NOLASCO, ISAIAS JR (BA)
Entity Type:Individual
Prefix:MR
First Name:ISAIAS
Middle Name:
Last Name:NOLASCO
Suffix:JR
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5466 N. FIGARDEN AVE DR. #139
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-6033
Mailing Address - Country:US
Mailing Address - Phone:559-271-0264
Mailing Address - Fax:
Practice Address - Street 1:5466 N. FIGARDEN AVE DR. #139
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-6033
Practice Address - Country:US
Practice Address - Phone:559-271-0264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-16
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)