Healthcare Provider Details

I. General information

NPI: 1962648626
Provider Name (Legal Business Name): LITA & AVA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2008
Last Update Date: 12/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 S WINCHESTER BLVD
SAN JOSE CA
95128-3906
US

IV. Provider business mailing address

1250 S WINCHESTER BLVD
SAN JOSE CA
95128-3906
US

V. Phone/Fax

Practice location:
  • Phone: 408-241-3844
  • Fax: 408-241-6430
Mailing address:
  • Phone: 408-241-3844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number070000051
License Number StateCA

VIII. Authorized Official

Name: JULITA A JAVIER
Title or Position: PRESIDENT
Credential:
Phone: 408-241-3844