Basic Information
| Provider Information | |||||||||
| NPI: | 1497943369 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ISLAM | ||||||||
| FirstName: | NIMAT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3209 N ALAMEDA ST STE B | ||||||||
| Address2: | |||||||||
| City: | COMPTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902221455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3105372273 | ||||||||
| FaxNumber: | 3105372139 | ||||||||
| Practice Location | |||||||||
| Address1: | 3209 N ALAMEDA ST STE B | ||||||||
| Address2: | |||||||||
| City: | COMPTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902221455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3105372273 | ||||||||
| FaxNumber: | 3105372139 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2007 | ||||||||
| LastUpdateDate: | 10/04/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 10501011547 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.