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General NPI Number Information
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NPI Number | 1336817436
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Entity Type | Organization
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Legal Business Name | HEALTHCOSMOS OF NEVADA PROFESSIONAL LIMITED LIABILITY CORPORATION
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Dates
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Enumeration Date | 09/02/2021
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Last Update Date | 09/02/2021
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Provider Practice Location Address
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Address Line | 1100 E GREEN ST
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City | PASADENA
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State | CA
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Zip | 91106-2513
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Country | US
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Telephone | 626-922-6821
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 E GREEN ST
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City | PASADENA
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State | CA
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Zip | 91106-2513
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Country | US
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Telephone | 626-922-6821
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Fax |
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Authorized Official
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Title or Position | GENERAL COUNSEL
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Name | MR. MICHAEL G POLIS
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Credential | ESQ, CPA
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Telephone | 626-922-6821
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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