Healthcare Provider Details

I. General information

NPI: 1629323399
Provider Name (Legal Business Name): MRS. TERESITA CAPA HERNANDEZ-THORPE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2012
Last Update Date: 07/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 DEL CAMPO LN
CARMICHAEL CA
95608-0124
US

IV. Provider business mailing address

5901 DEL CAMPO LANE
CARMICHAEL CA
95608
US

V. Phone/Fax

Practice location:
  • Phone: 916-349-2387
  • Fax: 916-349-8092
Mailing address:
  • Phone: 916-349-2387
  • Fax: 916-349-8092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number347004737
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: