Healthcare Provider Details

I. General information

NPI: 1598344269
Provider Name (Legal Business Name): CALIFORNIA AUTHORITY ON AGING RESOURCES AND EDUCATION SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2021
Last Update Date: 04/07/2021
Certification Date: 04/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3628 LYNOAK DR STE 104
CLAREMONT CA
91711-3243
US

IV. Provider business mailing address

3628 LYNOAK DR STE 104
CLAREMONT CA
91711-3243
US

V. Phone/Fax

Practice location:
  • Phone: 909-566-3700
  • Fax:
Mailing address:
  • Phone: 909-566-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number StateNULL

VIII. Authorized Official

Name: TAMARA JENNINGS
Title or Position: CEO
Credential:
Phone: 909-566-3700