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Nursing Service Related Providers Chore Provider

Provider NPI: 1154421956

Provider Information:
Gender: M
Sole Proprietor

Practice Location:
2776 PACIFIC AVE  LONG BEACH, CA 90806-2613 US
Tel: 714-973-2650  Fax: 714-973-2655

Business Mailing Address:
1826 MCNAB AVE  LONG BEACH, CA 90815-4538 US
Tel: 562-493-1783  Fax: --

NPI Information:
NPI: 1154421956
Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
N372500000XNursing Service Related Providers
Chore Provider
Y367500000XPhysician Assistants & Advanced Practice Nursing Providers
Nurse Anesthetist, Certified Registered

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 367500000X





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