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Individual

JIM BACANI

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
10865 BEACH BLVD, STANTON, CA 90680-3053
(626) 807-0401
(714) 333-4980
Mailing address
5830 HARRISON ST, CHINO, CA 91710-2628
(626) 807-0401

Taxonomy

Speciality
Code
Description
License number
State
251G00000X
Community Based Hospice Care Agency
315D00000X
Inpatient Hospice
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
332BC3200X
Customized Equipment (DME)
332BD1200X
Dialysis Equipment & Supplies (DME)
332BN1400X
Nursing Facility Supplies (DME)
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
332BX2000X
Oxygen Equipment & Supplies (DME)

Other

Enumeration date
06/19/2018
Last updated
08/30/2023
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