Healthcare Provider Details

I. General information

NPI: 1346593258
Provider Name (Legal Business Name): CLARISSA LAQUI DIMACALI CNA, HOME HEALTH AID
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2012
Last Update Date: 10/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 W. MANOR DR # 1393
PACIFICA CA
94044
US

IV. Provider business mailing address

P.O. BOX 1393
PACIFICA CA
94044
US

V. Phone/Fax

Practice location:
  • Phone: 650-498-7442
  • Fax:
Mailing address:
  • Phone: 650-438-9347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number0039232800117875
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: