Healthcare Provider Details

I. General information

NPI: 1992831754
Provider Name (Legal Business Name): NIFA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 01/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 S MAIN AVE
FALLBROOK CA
92028-3325
US

IV. Provider business mailing address

PO BOX 2797
FALLBROOK CA
92088-2797
US

V. Phone/Fax

Practice location:
  • Phone: 760-731-0313
  • Fax: 760-731-0414
Mailing address:
  • Phone: 760-731-0313
  • Fax: 760-731-0414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name: GARY HARGREAVES
Title or Position: PRESIDENT
Credential:
Phone: 760-731-0313