Provider Demographics
NPI:1659614519
Name:CORYSSAPHER NICHOLAS ENTERPRISES INC
Entity Type:Organization
Organization Name:CORYSSAPHER NICHOLAS ENTERPRISES INC
Other - Org Name:OSTOMYSUPPLIES.BIZ
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ALYSSA
Authorized Official - Middle Name:
Authorized Official - Last Name:THALMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-705-4269
Mailing Address - Street 1:1753 GARNET AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-3351
Mailing Address - Country:US
Mailing Address - Phone:760-705-4269
Mailing Address - Fax:
Practice Address - Street 1:1753 GARNET AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-3351
Practice Address - Country:US
Practice Address - Phone:760-705-4269
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-29
Last Update Date:2013-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies