Healthcare Provider Details

I. General information

NPI: 1568872851
Provider Name (Legal Business Name): FIDELIA HOSPICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2014
Last Update Date: 12/31/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4210 EAGLE ROCK BLVD. SUITE 201
LOS ANGELES CA
90065-4543
US

IV. Provider business mailing address

4210 EAGLE ROCK BLVD. SUITE 201
LOS ANGELES CA
90065-4543
US

V. Phone/Fax

Practice location:
  • Phone: 562-403-0306
  • Fax: 562-332-6175
Mailing address:
  • Phone: 562-403-0306
  • Fax: 562-332-6175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. AUGUSTO SANTOS
Title or Position: CEO
Credential: CEO
Phone: 562-403-0306