Basic Information
| Provider Information | |||||||||
| NPI: | 1083712145 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NACINO | ||||||||
| FirstName: | ISMAEL | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12543 WINERY DR | ||||||||
| Address2: | |||||||||
| City: | RANCHO CUCAMONGA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917398834 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9098997413 | ||||||||
| FaxNumber: | 9098991043 | ||||||||
| Practice Location | |||||||||
| Address1: | 2445 W WHITTIER BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | MONTEBELLO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3237272550 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 10/29/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | A44650 | CA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 00A446500 | 05 | CA | MEDICAID |