Organization
CORE IV HYDRATION AND MED SPA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIM NISSEN RN (OWNER)
(415) 850-3447
Entity
Organization
Contact information
Practice address
1 BLACKFIELD DR SUITE 2 #307, TIBURON, CA 94920
(415) 850-3447
Mailing address
1 BLACKFIELD DR SUITE 2 #307, TIBURON, CA 94920
(415) 850-3447
Taxonomy
Speciality
Code
Description
License number
State
163WI0500X
Infusion Therapy Registered Nurse
Primary
—
—
Other
Enumeration date
07/23/2026
Last updated
07/23/2026
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