Healthcare Provider Details

I. General information

NPI: 1538075247
Provider Name (Legal Business Name): NIMBUS MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 VISTAMAR DR
LAGUNA NIGUEL CA
92677-5640
US

IV. Provider business mailing address

16 VISTAMAR DR
LAGUNA NIGUEL CA
92677-5640
US

V. Phone/Fax

Practice location:
  • Phone: 385-528-4530
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MARK HOLMES
Title or Position: CEO
Credential:
Phone: 385-528-4530