Healthcare Provider Details

I. General information

NPI: 1205811601
Provider Name (Legal Business Name): CREDENA HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2005
Last Update Date: 07/25/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 W LA VETA AVE
ORANGE CA
92868-4225
US

IV. Provider business mailing address

PO BOX 2704
PORTLAND OR
97208-2704
US

V. Phone/Fax

Practice location:
  • Phone: 714-744-8724
  • Fax: 714-744-8676
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. MIKE SKAFI
Title or Position: AVP/SECRETARY
Credential:
Phone: 575-650-3396