1679708465 NPI number — HESTIA HOSPICE AND PALLIATIVE CARE CORP

Table of content: MRS. SUSIVIEN CUNANAN MARTINEZ DMD (NPI 1295747251)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679708465 NPI number — HESTIA HOSPICE AND PALLIATIVE CARE CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HESTIA HOSPICE AND PALLIATIVE CARE CORP
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:
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:
1679708465
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/31/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15545 DEVONSHIRE ST STE 311
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MISSION HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91345-3302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-578-4039
Provider Business Mailing Address Fax Number:
800-376-4054

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15545 DEVONSHIRE ST STE 311
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MISSION HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91345-3302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-578-4039
Provider Business Practice Location Address Fax Number:
800-376-4054
Provider Enumeration Date:
05/21/2009

Additional Information

Authorized Official

Authorized Official Last Name:
TAGUM
Authorized Official First Name:
JOIE
Authorized Official Middle Name:
MIRANDO
Authorized Official Title or Position:
CEO/PRESIDENT
Authorized Official Telephone Number:
800-578-4039

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , 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)





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