Healthcare Provider Details

I. General information

NPI: 1295823318
Provider Name (Legal Business Name): COMPLETE INFUSION CARE,CIC,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2310 S SEPULVEDA BLVD
LOS ANGELES CA
90064-1911
US

IV. Provider business mailing address

2310 S SEPULVEDA BLVD
LOS ANGELES CA
90064-1911
US

V. Phone/Fax

Practice location:
  • Phone: 310-836-6666
  • Fax: 310-836-6675
Mailing address:
  • Phone: 310-836-6666
  • Fax: 310-836-6675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License NumberPHY46839
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number StateNULL

VIII. Authorized Official

Name: MICHAEL HOUSKE
Title or Position: GENERAL COUNSEL AND EXECUTIVE VP
Credential:
Phone: 310-836-6666