Provider Demographics
NPI:1902294259
Name:BLISS, NICHOLAS (HIS)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:
Last Name:BLISS
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 SPRING OAK RD UNIT 2126
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-7518
Mailing Address - Country:US
Mailing Address - Phone:860-256-1151
Mailing Address - Fax:
Practice Address - Street 1:321 S MOORPARK RD
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91361
Practice Address - Country:US
Practice Address - Phone:805-418-9850
Practice Address - Fax:805-777-4747
Is Sole Proprietor?:No
Enumeration Date:2015-01-08
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8262237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1629261078Other2-ORG