Healthcare Provider Details

I. General information

NPI: 1053395921
Provider Name (Legal Business Name): UNICARE CALI HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 05/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 S MOUNT VERNON AVE STE 100
COLTON CA
92324-3928
US

IV. Provider business mailing address

930 S MOUNT VERNON AVE STE 100
COLTON CA
92324-3928
US

V. Phone/Fax

Practice location:
  • Phone: 909-317-3100
  • Fax: 909-317-3101
Mailing address:
  • Phone: 909-317-3100
  • Fax: 909-317-3101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHY45319
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPHY45319
License Number StateCA

VIII. Authorized Official

Name: MR. GOPAL SOJITRA
Title or Position: SECRETARY/PHARMACIST
Credential: PHARM D
Phone: 909-317-3100