1275136335 NPI number — SPECIALTY INFUSIONS NURSING CARE

Table of content: (NPI 1275136335)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275136335 NPI number — SPECIALTY INFUSIONS NURSING CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPECIALTY INFUSIONS NURSING CARE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275136335
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/19/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14664 MARIGOLD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORO GRANDE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92368-9553
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-438-5264
Provider Business Mailing Address Fax Number:
833-945-1164

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
222 E MAIN ST STE 216
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARSTOW
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92311-2366
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
442-295-9102
Provider Business Practice Location Address Fax Number:
833-245-1164
Provider Enumeration Date:
11/19/2020

Additional Information

Authorized Official

Authorized Official Last Name:
CASTLEMAN
Authorized Official First Name:
NANCY
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
442-295-9102

Provider Taxonomy Codes

  • Taxonomy code: 251F00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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