Provider Demographics
NPI:1871514497
Name:NOCELLA, JOHN JOSEPH (PA)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:JOSEPH
Last Name:NOCELLA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11500 SAN VINCENTE BLVD
Mailing Address - Street 2:STE 409
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-6218
Mailing Address - Country:US
Mailing Address - Phone:310-826-2073
Mailing Address - Fax:310-826-9353
Practice Address - Street 1:3630 EAST IMPERIAL HIGHWAY
Practice Address - Street 2:STE 2101
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-2636
Practice Address - Country:US
Practice Address - Phone:310-603-6562
Practice Address - Fax:310-669-8236
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR40761363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
R40761Medicare UPIN
CAWPA12692FMedicare ID - Type Unspecified