Basic Information
| Provider Information | |||||||||
| NPI: | 1619328952 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PARTIDA | ||||||||
| FirstName: | NOEHLY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1337 S PALOMARES ST | ||||||||
| Address2: | |||||||||
| City: | POMONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917664517 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9092925600 | ||||||||
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| Practice Location | |||||||||
| Address1: | 790 E BONITA AVE | ||||||||
| Address2: | |||||||||
| City: | POMONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917671906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9096257207 | ||||||||
| FaxNumber: | 9096261524 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2016 | ||||||||
| LastUpdateDate: | 07/30/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 167G00000X | 40124 | CA | Y | Nursing Service Providers | Licensed Psychiatric Technician |
ID Information
| ID | Type | State | Issuer | Description | 007848 | 05 | CA | MEDICAID |