Healthcare Provider Details

I. General information

NPI: 1891999785
Provider Name (Legal Business Name): NSR MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 03/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 IMPERIAL HWY SUITE D
DOWNEY CA
90242-3469
US

IV. Provider business mailing address

PO BOX 2579
DOWNEY CA
90242-1579
US

V. Phone/Fax

Practice location:
  • Phone: 562-803-6116
  • Fax: 562-803-6308
Mailing address:
  • Phone: 562-803-6116
  • Fax: 562-803-6308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG82333
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG51854
License Number StateCA

VIII. Authorized Official

Name: MRS. WENDY CASTANEDA
Title or Position: ADMINISTRATOR
Credential:
Phone: 562-803-6116