Provider Demographics
NPI:1861909079
Name:ICA FAMILY NURSING PRACTICE
Entity type:Organization
Organization Name:ICA FAMILY NURSING PRACTICE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IDALIA
Authorized Official - Middle Name:CORTEZ
Authorized Official - Last Name:ABLIN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:661-363-7000
Mailing Address - Street 1:5917 NILES ST STE 2
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93306-4695
Mailing Address - Country:US
Mailing Address - Phone:661-363-7000
Mailing Address - Fax:661-493-0502
Practice Address - Street 1:5917 NILES ST STE 2
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93306-4695
Practice Address - Country:US
Practice Address - Phone:661-363-7000
Practice Address - Fax:661-493-0502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-09
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty