Provider Demographics
NPI:1952865198
Name:INDUSTRIAL CARE SPECIALIST
Entity Type:Organization
Organization Name:INDUSTRIAL CARE SPECIALIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CATHIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BACON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-202-6970
Mailing Address - Street 1:PO BOX 33
Mailing Address - Street 2:
Mailing Address - City:PORT HUENEME
Mailing Address - State:CA
Mailing Address - Zip Code:93044-0033
Mailing Address - Country:US
Mailing Address - Phone:619-202-6970
Mailing Address - Fax:619-202-6971
Practice Address - Street 1:5565 GROSSMONT CENTER DR STE 259
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3098
Practice Address - Country:US
Practice Address - Phone:619-315-0336
Practice Address - Fax:619-315-0338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-22
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty