Healthcare Provider Details

I. General information

NPI: 1861266710
Provider Name (Legal Business Name): SULOCHANA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2023
Last Update Date: 12/29/2023
Certification Date: 12/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 TERRADO PLZ STE 31
COVINA CA
91723-3445
US

IV. Provider business mailing address

PO BOX 4668
COVINA CA
91723-4668
US

V. Phone/Fax

Practice location:
  • Phone: 626-938-0113
  • Fax: 626-938-0123
Mailing address:
  • Phone: 626-938-0113
  • Fax: 626-938-0123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: RUSHIKA MEDIWAKE
Title or Position: PRESIDENT
Credential:
Phone: 626-938-0113