Provider Demographics
NPI:1891999785
Name:NSR MEDICAL
Entity Type:Organization
Organization Name:NSR MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTANEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-803-6116
Mailing Address - Street 1:PO BOX 2579
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90242-1579
Mailing Address - Country:US
Mailing Address - Phone:562-803-6116
Mailing Address - Fax:562-803-6308
Practice Address - Street 1:7700 IMPERIAL HWY
Practice Address - Street 2:SUITE D
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242-3469
Practice Address - Country:US
Practice Address - Phone:562-803-6116
Practice Address - Fax:562-803-6308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG51854174400000X
CAG82333174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG79545Medicare UPIN
CAA93117Medicare UPIN