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General NPI Number Information
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NPI Number | 1053805341
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Entity Type | Individual
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Provider Name | JIM BACANI
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Gender | Male
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Dates
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Enumeration Date | 06/19/2018
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Last Update Date | 08/30/2023
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Provider Practice Location Address
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Address Line | 10865 BEACH BLVD
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City | STANTON
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State | CA
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Zip | 90680-3053
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Country | US
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Telephone | 626-807-0401
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Fax | 714-333-4980
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Provider Business Mailing Address
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Address Line | 5830 HARRISON ST
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City | CHINO
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State | CA
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Zip | 91710-2628
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Country | US
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Telephone | 626-807-0401
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315D00000X
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Taxonomy Name | Inpatient Hospice
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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Taxonomy #3
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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Taxonomy #4
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Taxonomy Code | 332BD1200X
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Taxonomy Name | Dialysis Equipment & Supplies (DME)
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License Number |
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Taxonomy #5
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Taxonomy Code | 332BN1400X
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Taxonomy Name | Nursing Facility Supplies (DME)
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License Number |
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Taxonomy #6
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number |
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Taxonomy #7
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number |
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Taxonomy #8
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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