Healthcare Provider Details

I. General information

NPI: 1598692253
Provider Name (Legal Business Name): JED MARC CALVENTAS ADOLFO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 S SANTA CRUZ ST STE 225
ANAHEIM CA
92805-6821
US

IV. Provider business mailing address

2040 S SANTA CRUZ ST STE 225
ANAHEIM CA
92805-6821
US

V. Phone/Fax

Practice location:
  • Phone: 949-378-4525
  • Fax:
Mailing address:
  • Phone: 949-378-4525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number304700246
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: