Healthcare Provider Details

I. General information

NPI: 1477615797
Provider Name (Legal Business Name): PARA & PALLI INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 07/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

931 IDAHO AVE
LOS BANOS CA
93635-3405
US

IV. Provider business mailing address

931 IDAHO AVE
LOS BANOS CA
93635-3405
US

V. Phone/Fax

Practice location:
  • Phone: 209-826-0790
  • Fax: 209-826-3154
Mailing address:
  • Phone: 209-826-0790
  • Fax: 209-826-3154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number040000202
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License NumberNHA00006564
License Number StateCA

VIII. Authorized Official

Name: MR. JOSPEH PALLIVATHUCAL
Title or Position: GENERAL MANAGER
Credential:
Phone: 209-826-0790