Provider Demographics
NPI:1295823318
Name:COMPLETE INFUSION CARE,CIC,INC
Entity Type:Organization
Organization Name:COMPLETE INFUSION CARE,CIC,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL COUNSEL AND EXECUTIVE VP
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HOUSKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-836-6666
Mailing Address - Street 1:2310 S SEPULVEDA BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-1911
Mailing Address - Country:US
Mailing Address - Phone:310-836-6666
Mailing Address - Fax:310-836-6675
Practice Address - Street 1:2310 S SEPULVEDA BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-1911
Practice Address - Country:US
Practice Address - Phone:310-836-6666
Practice Address - Fax:310-836-6675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0004X, 3336L0003X, 3336S0011X, 3336C0004X
CAPHY468393336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA468390Medicaid
=========OtherTAX I.D.#
CAPHA468390Medicaid