MEDICARE: DSP HOME HEALTH, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency		CA

General Provider Information

NPI Number	:	1275679946
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DSP HOME HEALTH, INC.

Provider Business Mailing Address
First Line	:	1815 E WORKMAN AVE
Second Line	:	SUITE D
City	:	WEST COVINA
State	:	CA
Zip	:	91791-1423
Country	:	US
Telephone Number	:	626-331-2265
Fax Number	:	626-331-7135

Provider Business Practice Location Address
First Line	:	1815 E WORKMAN AVE
Second Line	:	SUITE D
City	:	WEST COVINA
State	:	CA
Zip	:	91791-1423
Country	:	US
Telephone Number	:	626-331-2265
Fax Number	:	626-331-7135

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. MARICON PADUA PARDUCHO
Credential	:
Telephone Number	:	626-331-2265

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	08/22/2020

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