1588008361 NPI number — MEDI-CURE HEALTH SERVICES

Table of content: JENNA TRISCARI MSW, LICSW (NPI 1063925584)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588008361 NPI number — MEDI-CURE HEALTH SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDI-CURE HEALTH SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588008361
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/23/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3756 SANTA ROSALIA DR
Provider Second Line Business Mailing Address:
417
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90008-3606
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-295-1136
Provider Business Mailing Address Fax Number:
323-295-1071

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1921 WEST ARROYO STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POMONA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91768
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-295-1136
Provider Business Practice Location Address Fax Number:
323-295-1071
Provider Enumeration Date:
04/23/2013

Additional Information

Authorized Official

Authorized Official Last Name:
KANNIKE-MARTINS
Authorized Official First Name:
JOSEPHINE
Authorized Official Middle Name:
C
Authorized Official Title or Position:
EXECUTIVE DIRECTOR/CEO
Authorized Official Telephone Number:
323-295-1136

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  190636AN , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 190636 AN . This is a "MEDICAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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