Healthcare Provider Details

I. General information

NPI: 1447521687
Provider Name (Legal Business Name): INFUSION SOLUTIONS OF CALIFORNIA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2012
Last Update Date: 01/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6719 ALVARADO RD SUITE 206
SAN DIEGO CA
92120-5270
US

IV. Provider business mailing address

PO BOX 710488
SAN DIEGO CA
92171-0488
US

V. Phone/Fax

Practice location:
  • Phone: 619-326-0700
  • Fax:
Mailing address:
  • Phone: 619-326-0700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License NumberC3335521
License Number StateCA

VIII. Authorized Official

Name: KIM NISSEN
Title or Position: PRESIDENT
Credential:
Phone: 619-326-0700