Healthcare Provider Details

I. General information

NPI: 1205066867
Provider Name (Legal Business Name): CALIFORNIA PALLIATIVE CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2009
Last Update Date: 03/07/2023
Certification Date: 11/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E MINERAL KING AVE
VISALIA CA
93291-6923
US

IV. Provider business mailing address

529 E CHESAPEAKE CIR
FRESNO CA
93730-0740
US

V. Phone/Fax

Practice location:
  • Phone: 559-450-4634
  • Fax:
Mailing address:
  • Phone: 559-303-3666
  • Fax: 888-874-6892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberA55139
License Number StateCA

VIII. Authorized Official

Name: MICHAEL JOSEPH NISCO
Title or Position: PRESIDENT
Credential: MD
Phone: 559-303-3666