Individual
DUSTIN NICOLARSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
205 HIGHLAND PL, MONROVIA, CA 91016-2015
(310) 906-6779
Mailing address
205 HIGHLAND PL, MONROVIA, CA 91016-2015
(310) 906-6779
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NA
NA
CA
Enumeration date
02/09/2022
Last updated
02/09/2022
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