Healthcare Provider Details

I. General information

NPI: 1366443103
Provider Name (Legal Business Name): CIROCA CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13624 HAWTHORNE BLVD SUITE 102
HAWTHORNE CA
90250-5818
US

IV. Provider business mailing address

13624 HAWTHORNE BLVD SUITE 102
HAWTHORNE CA
90250-5818
US

V. Phone/Fax

Practice location:
  • Phone: 310-679-9844
  • Fax: 310-679-7964
Mailing address:
  • Phone: 310-679-9844
  • Fax: 310-679-7964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberPHY46241
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License NumberPHY46241
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License NumberPHY46241
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHY46241
License Number StateCA

VIII. Authorized Official

Name: MR. JAIRO DE LA ROSA
Title or Position: VICEPRESIDENT
Credential:
Phone: 310-679-9844