Healthcare Provider Details

I. General information

NPI: 1124405881
Provider Name (Legal Business Name): HEALTH CARE INTEGRATED SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2015
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 N CENTRAL AVE B1
COMPTON CA
90222-1640
US

IV. Provider business mailing address

PO BOX 213093
CHULA VISTA CA
91921-3093
US

V. Phone/Fax

Practice location:
  • Phone: 888-417-5163
  • Fax: 888-316-1604
Mailing address:
  • Phone: 888-417-5163
  • Fax: 888-316-1604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number960001448
License Number StateCA

VIII. Authorized Official

Name: JUSTIN C MILLER
Title or Position: PRESIDENT & CEO
Credential:
Phone: 888-417-5163