Provider Demographics
NPI:1851580625
Name:NISSAN PILEST, MD INC
Entity Type:Organization
Organization Name:NISSAN PILEST, MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DANICA
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:949-727-3800
Mailing Address - Street 1:16100 SAND CANYON AVE STE 190
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3723
Mailing Address - Country:US
Mailing Address - Phone:949-727-3800
Mailing Address - Fax:949-727-3888
Practice Address - Street 1:16100 SAND CANYON AVE STE 190
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3723
Practice Address - Country:US
Practice Address - Phone:949-727-3800
Practice Address - Fax:949-727-3888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ58657ZOtherBLUE SHIELD GROUP PIN
CAZZZ58657ZOtherBLUE SHIELD GROUP PIN