Basic Information
Provider Information
NPI: 1346722063
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NOLASCO
FirstName: PACITA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5000 W OAKEY BLVD
Address2:  
City: LAS VEGAS
State: NV
PostalCode: 891463393
CountryCode: US
TelephoneNumber: 7027332890
FaxNumber:  
Practice Location
Address1: 5000 W OAKEY BLVD
Address2:  
City: LAS VEGAS
State: NV
PostalCode: 891463393
CountryCode: US
TelephoneNumber: 7027332890
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/29/2018
LastUpdateDate: 08/29/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
3747P1801X NVY Nursing Service Related ProvidersTechnicianPersonal Care Attendant
372500000X NVN Nursing Service Related ProvidersChore Provider 
372600000X NVN Nursing Service Related ProvidersAdult Companion 
3747A0650X NVN Nursing Service Related ProvidersTechnicianAttendant Care Provider
376J00000X NVN Nursing Service Related ProvidersHomemaker 

No ID Information.


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