Provider Demographics
NPI:1538826060
Name:ELIZABETH NIMNI MEDICAL CORPORATION
Entity type:Organization
Organization Name:ELIZABETH NIMNI MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:NIMNI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-405-4703
Mailing Address - Street 1:1628 COMSTOCK AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-5321
Mailing Address - Country:US
Mailing Address - Phone:310-405-4703
Mailing Address - Fax:
Practice Address - Street 1:8631 W 3RD ST # 1030E
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5901
Practice Address - Country:US
Practice Address - Phone:310-307-6100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-18
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty