Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 95000408 | CA |
NPI | 1003206103 |
---|---|
Provider Name | Mrs. Nicole Ninofranco Alcantara |
First Address | Tustin, CA 92780 |
Second Address | Tustin, CA 92780 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2015 |
Last Update Date | 27/01/2015 |