Healthcare Provider Details

I. General information

NPI: 1053537761
Provider Name (Legal Business Name): CHILDREN'S CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1529 E PALMDALE BLVD STE 306
PALMDALE CA
93550-2030
US

IV. Provider business mailing address

1529 E PALMDALE BLVD STE 306
PALMDALE CA
93550-2030
US

V. Phone/Fax

Practice location:
  • Phone: 661-274-1200
  • Fax:
Mailing address:
  • Phone: 661-274-1200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberA66291
License Number StateCA

VIII. Authorized Official

Name: MEL IGNACIO
Title or Position: OFFICE MANAGER
Credential:
Phone: 661-274-1200