Healthcare Provider Details

I. General information

NPI: 1497943369
Provider Name (Legal Business Name): NIMAT ISLAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2007
Last Update Date: 10/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3209 N ALAMEDA ST STE B
COMPTON CA
90222-1455
US

IV. Provider business mailing address

3209 N ALAMEDA ST STE B
COMPTON CA
90222-1455
US

V. Phone/Fax

Practice location:
  • Phone: 310-537-2273
  • Fax: 310-537-2139
Mailing address:
  • Phone: 310-537-2273
  • Fax: 310-537-2139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number10501011547
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: