Healthcare Provider Details

I. General information

NPI: 1609793868
Provider Name (Legal Business Name): SENIORCARE AT NORTHRIDGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19241 CALAHAN ST
NORTHRIDGE CA
91324
US

IV. Provider business mailing address

19241 CALAHAN ST
NORTHRIDGE CA
91324
US

V. Phone/Fax

Practice location:
  • Phone: 818-727-0338
  • Fax:
Mailing address:
  • Phone: 818-727-0338
  • Fax: 818-477-2288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: MR. JAIME P MONTERO
Title or Position: ADMINISTRATOR
Credential:
Phone: 818-727-0338