Healthcare Provider Details

I. General information

NPI: 1598112708
Provider Name (Legal Business Name): NGK CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2016
Last Update Date: 01/11/2023
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16870 W BERNARDO DR STE 400
SAN DIEGO CA
92127-1678
US

IV. Provider business mailing address

16870 W BERNARDO DR STE 400
SAN DIEGO CA
92127-1678
US

V. Phone/Fax

Practice location:
  • Phone: 858-774-4289
  • Fax: 858-408-1868
Mailing address:
  • Phone: 858-774-4289
  • Fax: 858-408-1868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number374700077
License Number StateCA

VIII. Authorized Official

Name: MS. NINA J HAINES
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 858-774-4289