Healthcare Provider Details

I. General information

NPI: 1609153436
Provider Name (Legal Business Name): INTERGRATED COMMUNITY HEALTHCARE SOLUTIONS (ICHS)
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2011
Last Update Date: 11/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8332 COMMONWEALTH AVE
BUENA PARK CA
90621-2526
US

IV. Provider business mailing address

8332 COMMONWEALTH AVE
BUENA PARK CA
90621-2526
US

V. Phone/Fax

Practice location:
  • Phone: 714-522-8242
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN NISHIMOTO
Title or Position: OFFICER
Credential: O.D, M.B.A.
Phone: 714-449-7409