Provider Demographics
NPI:1679971972
Name:NURISTANI, ANGELA
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:NURISTANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33363 WALLACE WAY
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-3471
Mailing Address - Country:US
Mailing Address - Phone:619-808-1123
Mailing Address - Fax:909-918-0063
Practice Address - Street 1:33363 WALLACE WAY
Practice Address - Street 2:
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-3471
Practice Address - Country:US
Practice Address - Phone:619-808-1123
Practice Address - Fax:909-918-0063
Is Sole Proprietor?:No
Enumeration Date:2014-12-18
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide