Healthcare Provider Details

I. General information

NPI: 1982900346
Provider Name (Legal Business Name): CALIFORNIA CARE CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2011
Last Update Date: 02/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 N CENTRAL AVE STE 106
GLENDALE CA
91203-1418
US

IV. Provider business mailing address

610 N CENTRAL AVE
GLENDALE CA
91203-1403
US

V. Phone/Fax

Practice location:
  • Phone: 818-551-0026
  • Fax: 818-551-0027
Mailing address:
  • Phone: 818-551-0026
  • Fax: 818-551-0027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number197331
License Number StateCA

VIII. Authorized Official

Name: RUTH A MASTERSON
Title or Position: COUNSELOR
Credential:
Phone: 818-551-0026