MEDICARE: ST CARMEN HEALTH PROVIDERS, 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	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1336403831
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST CARMEN HEALTH PROVIDERS, INC.

Provider Business Mailing Address
First Line	:	2030 E ROUTE 66 STE 200
Second Line	:
City	:	GLENDORA
State	:	CA
Zip	:	91740-4602
Country	:	US
Telephone Number	:	626-335-2167
Fax Number	:	626-387-9991

Provider Business Practice Location Address
First Line	:	2030 E ROUTE 66 STE 200
Second Line	:
City	:	GLENDORA
State	:	CA
Zip	:	91740-4602
Country	:	US
Telephone Number	:	626-335-2167
Fax Number	:	626-387-9991

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	ROSEBELLE DAVID SOTTO
Credential	:
Telephone Number	:	858-602-6546

Provider Enumeration Date	:	06/28/2012
Last Update Date	:	11/24/2025

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