Healthcare Provider Details

I. General information

NPI: 1326354333
Provider Name (Legal Business Name): NINAK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2010
Last Update Date: 08/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1916 EVANS AVE
CHEYENNE WY
82001-3716
US

IV. Provider business mailing address

23371 MULHOLLAND DR # 327
WOODLAND HILLS CA
91364-2734
US

V. Phone/Fax

Practice location:
  • Phone: 248-525-5314
  • Fax: 877-353-2634
Mailing address:
  • Phone: 248-525-5314
  • Fax: 877-353-2634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License NumberW306535
License Number StateWY

VIII. Authorized Official

Name: VICTOR ABIRAGI
Title or Position: MEDICAL PRACTICE MANAGER
Credential: M.D.,
Phone: 248-252-5314