Healthcare Provider Details

I. General information

NPI: 1679160931
Provider Name (Legal Business Name): CULTURE OF LIFE FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2020
Last Update Date: 10/10/2023
Certification Date: 10/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

362 W MISSION AVE STE 105
ESCONDIDO CA
92025-1738
US

IV. Provider business mailing address

362 W MISSION AVE STE 105
ESCONDIDO CA
92025-1738
US

V. Phone/Fax

Practice location:
  • Phone: 760-741-1224
  • Fax: 760-741-7010
Mailing address:
  • Phone: 760-741-1224
  • Fax: 760-741-7010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARICAR GAGUCAS
Title or Position: GENERAL MANAGER
Credential: MBA
Phone: 619-518-8072