Healthcare Provider Details

I. General information

NPI: 1649990300
Provider Name (Legal Business Name): DANIEL ALDA JR. EXEMPTFROMLICENSURE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DANIEL ALDA JR. EXEMPTFROMLICENCSURE

II. Dates (important events)

Enumeration Date: 08/31/2022
Last Update Date: 07/11/2024
Certification Date: 07/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11001 BENTON ST
LOMA LINDA CA
92354-3102
US

IV. Provider business mailing address

11001 BENTON ST
LOMA LINDA CA
92354-3102
US

V. Phone/Fax

Practice location:
  • Phone: 909-507-1794
  • Fax:
Mailing address:
  • Phone: 909-507-1794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: