Healthcare Provider Details

I. General information

NPI: 1174398622
Provider Name (Legal Business Name): MIJI HEALTH CARE SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2023
Last Update Date: 11/15/2023
Certification Date: 11/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5805 SEPULVEDA BLVD STE 605
VAN NUYS CA
91411-2550
US

IV. Provider business mailing address

5805 SEPULVEDA BLVD STE 605
VAN NUYS CA
91411-2550
US

V. Phone/Fax

Practice location:
  • Phone: 818-902-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: NEIL ROTTER
Title or Position: CEO
Credential:
Phone: 818-990-2273