Healthcare Provider Details

I. General information

NPI: 1346723434
Provider Name (Legal Business Name): MAMA'S KITCHEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2018
Last Update Date: 09/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3960 HOME AVE
SAN DIEGO CA
92105-5925
US

IV. Provider business mailing address

3960 HOME AVE
SAN DIEGO CA
92105-5925
US

V. Phone/Fax

Practice location:
  • Phone: 619-233-6262
  • Fax:
Mailing address:
  • Phone: 619-233-6262
  • 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 Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State

VIII. Authorized Official

Name: MR. ALBERTO CORTES
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 619-233-6262