Healthcare Provider Details

I. General information

NPI: 1265481873
Provider Name (Legal Business Name): NISSIM INSTITUTIONAL PROVIDERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 01/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9612 VAN NUYS BLVD #108
PANORAMA CITY CA
91402-1044
US

IV. Provider business mailing address

2701 KIMBALL AVE
POMONA CA
91767-2268
US

V. Phone/Fax

Practice location:
  • Phone: 909-447-7040
  • Fax: 909-447-7030
Mailing address:
  • Phone: 909-447-7040
  • Fax: 909-447-7030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. HOWARD WEISS
Title or Position: OWNER
Credential:
Phone: 818-892-4555