Individual
MR. JOHN NIPPER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
11221 HOLMES AVE, MIRA LOMA, CA 91752-2552
(951) 741-5004
Mailing address
11221 HOLMES AVE, MIRA LOMA, CA 91752-2552
(951) 741-5004
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
101YA0400X
DOA COUNSELOR
CA
Enumeration date
03/08/2011
Last updated
03/08/2011
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