Healthcare Provider Details

I. General information

NPI: 1336748201
Provider Name (Legal Business Name): AVEEVA HOSPICE - SOUTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2020
Last Update Date: 04/26/2026
Certification Date: 04/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41197 GOLDEN GATE CIR STE 109
MURRIETA CA
92562-6999
US

IV. Provider business mailing address

PO BOX 638
SAN DIMAS CA
91773-0638
US

V. Phone/Fax

Practice location:
  • Phone: 951-405-3013
  • Fax: 951-405-3013
Mailing address:
  • Phone: 951-405-3013
  • Fax: 951-405-3013

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: JON H ESTANISLAO
Title or Position: ADMINISTRATOR
Credential:
Phone: 951-405-3013