Healthcare Provider Details

I. General information

NPI: 1003616590
Provider Name (Legal Business Name): CASA DE AMPARO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2025
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 RANCHO DEL ORO DR
OCEANSIDE CA
92057-7345
US

IV. Provider business mailing address

325 BUENA CREEK RD
SAN MARCOS CA
92069-9679
US

V. Phone/Fax

Practice location:
  • Phone: 760-295-4600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ERIN GOSPODAREC
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 760-566-3557