Provider Demographics
NPI:1952835365
Name:NOLASCO, CARL LEXCILLE C
Entity Type:Individual
Prefix:MR
First Name:CARL LEXCILLE
Middle Name:C
Last Name:NOLASCO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2107 MAYFAIR DR W
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93703-2312
Mailing Address - Country:US
Mailing Address - Phone:323-346-5196
Mailing Address - Fax:
Practice Address - Street 1:650 W ALLUVIAL AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-6716
Practice Address - Country:US
Practice Address - Phone:559-323-6200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-13
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist