Provider Demographics
NPI:1275852444
Name:INFUSION SOLUTIONS OF CALIFORNIA, INC
Entity Type:Organization
Organization Name:INFUSION SOLUTIONS OF CALIFORNIA, INC
Other - Org Name:INFUSION SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:NISSEN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:619-886-5057
Mailing Address - Street 1:P.O. BOX 881304
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92168
Mailing Address - Country:US
Mailing Address - Phone:619-886-5057
Mailing Address - Fax:760-758-4428
Practice Address - Street 1:6719 ALVARADO RD STE 206
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-5261
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:2010-05-26
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG27123261QI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy