Provider Demographics
NPI:1245583509
Name:CORE INTRAVENOUS SOLUTIONS INC
Entity Type:Organization
Organization Name:CORE INTRAVENOUS SOLUTIONS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:S
Authorized Official - Last Name:NISSEN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:619-886-5057
Mailing Address - Street 1:PO BOX 881304
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92168-1304
Mailing Address - Country:US
Mailing Address - Phone:619-886-5057
Mailing Address - Fax:760-758-4428
Practice Address - Street 1:2815 CAMINO DEL RIO S STE 115
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3816
Practice Address - Country:US
Practice Address - Phone:619-886-5057
Practice Address - Fax:760-758-4428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-23
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA532252261QI0500X
CAA77209261QI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy