Healthcare Provider Details

I. General information

NPI: 1548021132
Provider Name (Legal Business Name): MT PAGES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2024
Last Update Date: 02/19/2026
Certification Date: 02/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26322 TOWNE CENTRE DR APT 323
FOOTHILL RANCH CA
92610-2499
US

IV. Provider business mailing address

26322 TOWNE CENTRE DR APT 323
FOOTHILL RANCH CA
92610-2499
US

V. Phone/Fax

Practice location:
  • Phone: 562-551-9539
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251T00000X
TaxonomyPACE Provider Organization
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: TEY SISOWATH
Title or Position: ADMINISTRATOR
Credential:
Phone: 562-551-9539