Healthcare Provider Details

I. General information

NPI: 1043132269
Provider Name (Legal Business Name): DOLL FACE CLUB SOBER LIVING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1582 LA CORTA ST
LEMON GROVE CA
91945-4319
US

IV. Provider business mailing address

1582 LA CORTA ST
LEMON GROVE CA
91945-4319
US

V. Phone/Fax

Practice location:
  • Phone: 619-578-8503
  • Fax:
Mailing address:
  • Phone: 619-578-8503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: FLODIA NDOCI
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 619-578-8503